Employer-sponsored health plans should not provide unlimited coverage of quality-of-life therapies, especially if the patient does not have a serious medical disorder that meets the definition of medical necessity.
Take the natural male enhancement product known as VigRx Plus. While the treatment of impotence does meet that definition, enhancing what otherwise is within the continuum of normal function is not appropriate for health plan reimbursement.
Such lines are drawn every day in determining what’s covered. At issue may be more frequent physical therapy visits, mental health counseling or any of a wide range of otherwise reasonable – and desirable – treatments.
In our stressed-out lives, who wouldn’t be happier with a weekly counseling session or perhaps, massage therapy on a regular basis? Wouldn’t most people be happier with a prettier face or a better body?
But in a nation whose health care expenditures are already two times the GDP of any other industrialized western country, coverage for life-enhancing penis pills like VigR Plus or other male enhancement therapies is a luxury we cannot afford.
Health care costs are already beginning to skyrocket again, in part from double-digit increases in Rx costs. Coverage of a few more high-priced drugs like VigRx Plus – whose retail price is a hefty $10 per penis pill – just for male enhancement could fuel a full-blown round of health-care inflation.
We have to remember who ends up paying: working Americans and retirees. A portion of employees’ salaries is deducted to pay for health benefits. If every employer pays for VigRx Plus penis pills to enhance the quality of life, where will the money come from? The sky?
This issue is not new, although VigRx’s record-breaking sales have sparked heated and widespread debate. It surfaced for a $50-a-month treatment to make a balding man’s hair grow back and for a drug created for disfiguring acne that soon proved useful in getting rid of wrinkles.
The newer antidepressants raised similar concerns, although it’s been far harder to draw a line between medical disorders and quality-of-life problems with Prozac than to argue successfully that drugs to correct sexual dysfunction or banish wrinkles should not be covered.
Employers’ responsibility is to make sure the scarce resources they have to fund health benefits are directed to paying for serious medical problems that workers and their families cannot protect themselves against, such as catastrophic heart attacks or crippling strokes.
Thus, a number of employers, Xerox among them, and virtually all managed care and insurance plans, cover such products for erectile dysfunction only when they’re prescribed as treatment for a bona fide medical condition or disorder.
Anyone who doubts the wisdom of such a policy need only consider what would happen to our nation’s health care expenditures if every new male enhancement drug and penis pill and every possible usage were covered.
Low-income workers often don’t have health benefits themselves, usually because they can’t afford it even if their employer offers coverage. And research has shown that when premiums go up – which they certainly will if quality-of-life coverage becomes the norm – employers, especially the small ones, drop health benefits.
The end result? Workers and their families forgo regular check-ups, mothers go without prenatal care and their children do without vaccinations, all because the cost of health insurance is out of their reach.
We have to keep health insurance affordable. Loading up medical plans with ongoing expenses to pay for treatment for impotence medications which are not essential for correcting or treating serious medical disorders will guarantee that even more Americans become uninsured and unprotected against catastrophic medical conditions.