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Kaiser relents on Viagra. Business Insurance (Jan 4, 1999):1 (1 pages). COPYRIGHT 1999 Crain Communications Inc.

SACRAMENTO, Calif. -- The Kaiser Foundation Health Plan has agreed to pay the cost of the anti-impotence drug Viagra in California under a settlement reached with state regulators last week.

While Kaiser stopped paying for Viagra as of last April, it resumed payment when the drug was added to its formulary in September because Viagra couldn't be excluded unless authorized by the Department of Corporations, a spokesman said. As part of the agreement, Kaiser will pay the state $250,000 and resolve all grievances from members denied prescriptions for the drug from April to September.

Meanwhile, Kaiser's request to exclude Viagra from coverage still is pending with the Department of Corporations, which oversees health maintenance organizations in California.

A Kaiser spokesman explained that the HMO is seeking the exclusion because Viagra is a lifestyle drug.

Kaiser has received approval to exclude Viagra from its drug formulary in 12 other states and the District of Columbia; New York and Connecticut denied the exclusion. Besides California, regulators in Washington state also are considering Kaiser's exclusion application.

If the exclusion request is denied, California employers likely will see premium increases in 1999 to pay for the drug, the spokesman said. And if the exclusion is not permitted, the Department of Corporations has approved a 50% copayment for Viagra, vs. the usual $5-per- prescription copayment, he said. Viagra retails for about $8 to $10 a pill.

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