Some older gentlemen have been achieving a better love life courtesy of American taxpayers. A report from the inspector general of the federal Department of Health and Human Services, which administers Medicare, has divulged that Medicare erroneously has paid at least $3.1 million to cover erectile dysfunction drugs such as Viagra and Cialis.
The drugs help men achieve an erection, and Medicare shouldn’t haven’t paid for them.
Of approximately $133 billion in gross drug costs included in sponsors’ PDE data for CYs 2007 and 2008, [Center for Medicare and Medicare Services] accepted [prescription drug event] data totaling $3,107,200 in gross drug costs for ED drugs approved only for the treatment of sexual or erectile dysfunction. Pursuant to Federal requirements, Part D should not have covered these drugs.
“Part D” is prescription drug coverage Medicare approves for administration by a private insurance carrier.
According to HHS, Medicare paid $1.88 million in 2007 and $1.22 million in 2008 for the ED medications. Almost all of the $3.1 million Medicare paid went for Viagra. Much smaller amounts went for Cialis and Levitra and something called Caverject impulse powder, along with other Caverject products. Medicare also paid for erection suppositories.
Software The Problem
The report says a glitch in the agency’s computer software permitted the error.
According to officials, the software edit in place in CMS’s Medicare Drug Data Processing System during our audit period enabled CMS to identify and reject [prescription drug event] data that sponsors submitted for ED drugs prescribed for the treatment of sexual or erectile dysfunction. However, according to the officials, the edit did not prevent CMS from accepting PDE data for some ED drugs in CY 2007 and most of CY 2008 because the Part D program used an incomplete list of excluded drugs as the basis for the edit. Although the officials indicated that CMS had updated its list of ED drugs in CY 2008, CMS accepted PDE data for some ED drugs during our entire audit period.
Drugs such as Viagira, Cialis and Levitra are not approved for payment by Medicare unless “unless such drug were used to treat a condition, other than sexual or erectile dysfunction, for which the drug has been approved by the Food and Drug Administration.”
An erectile dysfunction (ED) drug meets the definition of a Part D drug when it is prescribed for medically accepted indications other than sexual or erectile dysfunction (such as pulmonary hypertension) for which the drug has been approved by FDA.
In other words, Medicare isn’t supposed to invest taxpayer money to enable the sex lives of elderly men.
According to the U.S. Debt Clock, the unfunded liability of Medicare and the prescription drug program is about $100 trillion.
