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Medicare Drug Program News
Erectile Dysfunction Drugs Being Dropped by Medicare
Drug Plans
Seniors finding Viagra, Cialis and Levitra have
disappeared
October 17, 2006 – Senior citizens checking out the
new Medicare drug plans for 2007 have found, what for many, is
disturbing news. Erectile dysfunction, which primarily plagues senior
men, is dropping off the Medicare radar and many – probably most - of
the plans will not cover the treatment drugs for this condition in 2007.
Viagra, Cialis and Levitra are drugs seniors are just not finding on the
formularies.
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This news break came in a story by Mary Jo
Feldstein in the St. Louis Post-Dispatch, who writes, "Most Medicare
prescription drug plans will stop covering Viagra and other erectile
dysfunction medications next year."
In older men, ED usually has a physical cause, such
as disease, injury, or side effects of drugs, according to the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Any
disorder that causes injury to the nerves or impairs blood flow in the
penis has the potential to cause ED.
The American Urological Association agrees, saying,
"By far, the most important cause of the development of ED is the
presence of illnesses like high blood pressure, diabetes mellitus, high
cholesterol levels and cardiovascular disease.
"These processes, acting over time, can lead to a
degeneration of the penile blood vessels, leading to restriction of
blood inflow through the arteries and also to leakage of blood through
the veins during erection."
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Go
to this story linked below to learn more about checking the new
drug plans for 2007 |
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Incidence increases with age: About 5 percent of
40-year-old men and between 15 and 25 percent of 65-year-old men
experience ED. But it is not an inevitable part of aging, the NIDDK
says. It is more likely the result of other illnesses that frequently
strike senior citizens.
ED is treatable at any age, and awareness of this
fact has been growing, states NIDDK. More men have been seeking help and
returning to normal sexual activity because of improved, successful
treatments for ED.
But, despite the need for relief by millions of
senior men suffering with this condition, the drugs are coming off the
formulary list of the Medicare drug plans.
Several insurers who run the drug plans said they
supported the change, according to the Post-Disptach. Dr. Charles
Willey, chief executive of Essence Inc. of Creve Coeur, one of the
insurers, said paying for the medications was not the best use of the
nation's limited health care dollars.
"We have to decide what our priorities are," said
Willey, whose Medicare Advantage plan offers drug, physician and
hospital coverage under one benefit, according to the newspaper.
All plans are not dropping the drugs. The Post-Disptach
says UnitedHealthcare Corp., for example, has one Medicare plan that
covers the drugs but its others do not.
The newspaper article says Medicare will continue
to cover the drugs if they're used to treat other conditions, such as
pulmonary hypertension, for which they've been approved.
There was opposition in the first year of the
Medicare drug program to adding the ED drugs to the coverage. Much of
the opposition was based on the cost. The Congressional Budget Office
estimated coverage of the drugs would cost Medicare almost $2 billion
over 10 years. The American Urological Association and drug
manufacturers encouraged the inclusion of the drugs.
The Department of Veterans Affairs, which covers
erectile-dysfunction medications, negotiates discounts on drugs, a
tactic Congress has denied Medicare, and they have achieved discounts of
up to 50 percent for the ED pills, which usually cost $9 to $11 each.
Many are concerned that the lack of access to these
drugs may lead men to dangerous solutions. The American Cancer Society
points out that "men and women seeking help for a sexual problem often
go to someone who is not really a health care professional. Sexual
problems are so common and upsetting that many will try unproven
remedies or cures.
"Although there is no evidence that any of the
following can cure a sexual problem, they are often said to be cures:
potency pills (such as “poppers” or “Spanish fly”), oysters,
“exercisers” that fit inside a woman’s vagina, hypnotism by someone not
trained as a mental health professional, or visits to an independent
“sexual surrogate.” Pursuing such treatments not only wastes your time
and money but can sometimes be harmful."
Links:
●
St. Louis Post-Dispatch story
..●
National Kidney and Urologic Diseases Information Clearing House of the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
●
American Urological Association
About Erectile Dysfunction
National Institute of Diabetes and Digestive and Kidney Diseases
Erectile dysfunction, or ED, can be a total
inability to achieve erection, an inconsistent ability to do so, or a
tendency to sustain only brief erections. These variations make defining
ED and estimating its incidence difficult.
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The first line of therapy for
uncomplicated ED is use of oral medications known as
phosphodiesterase-5 inhibitors (PDE-5) -- sildenafil citrate,
vardenafil HCl or tadalafil. Men with ED take these pills before
beginning sexual activity and the drugs boost the natural
signals that are generated during sex, thereby improving and
prolonging the erection itself. These medications are safe and
fairly effective, with improvement in erection in nearly 80
percent of patients using these drugs. Early concerns about
possible bad effects on the heart have not proven true; after
extensive testing and five years of use, sildenafil citrate can
be used safely by all heart patients except those using
medications called nitrates because of an interaction between
these two classes of drugs. – American Urological Association |
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Estimates range from 15 million to 30 million,
depending on the definition used. According to the National Ambulatory
Medical Care Survey (NAMCS), for every 1,000 men in the United States,
7.7 physician office visits were made for ED in 1985. By 1999, that rate
had nearly tripled to 22.3.
The increase happened gradually, presumably as
treatments such as vacuum devices and injectable drugs became more
widely available and discussing erectile function became accepted.
Perhaps the most publicized advance was the
introduction of the oral drug sildenafil citrate (Viagra) in March 1998.
NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra
at physician office visits in 1999, and one-third of those mentions
occurred during visits for a diagnosis other than ED.
Urologists, who specialize in problems of the
urinary tract, have traditionally treated ED; however, urologists
accounted for only 25 percent of Viagra mentions in 1999.
What causes erectile dysfunction (ED)?
Since an erection requires a precise sequence of
events, ED can occur when any of the events is disrupted. The sequence
includes nerve impulses in the brain, spinal column, and area around the
penis, and response in muscles, fibrous tissues, veins, and arteries in
and near the corpora cavernosa.
Damage to nerves, arteries, smooth muscles, and
fibrous tissues, often as a result of disease, is the most common cause
of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism,
multiple sclerosis, atherosclerosis, vascular disease, and neurologic
disease—account for about 70 percent of ED cases. Between 35 and 50
percent of men with diabetes experience ED.
Lifestyle choices that contribute to heart disease
and vascular problems also raise the risk of erectile dysfunction.
Smoking, being overweight, and avoiding exercise are possible causes of
ED.
Also, surgery (especially radical prostate and
bladder surgery for cancer) can injure nerves and arteries near the
penis, causing ED. Injury to the penis, spinal cord, prostate, bladder,
and pelvis can lead to ED by harming nerves, smooth muscles, arteries,
and fibrous tissues of the corpora cavernosa.
In addition, many common medicines—blood pressure
drugs, antihistamines, antidepressants, tranquilizers, appetite
suppressants, and cimetidine (an ulcer drug)—can produce ED as a side
effect.
Experts believe that psychological factors such as
stress, anxiety, guilt, depression, low self-esteem, and fear of sexual
failure cause 10 to 20 percent of ED cases. Men with a physical cause
for ED frequently experience the same sort of psychological reactions
(stress, anxiety, guilt, depression). Other possible causes are smoking,
which affects blood flow in veins and arteries, and hormonal
abnormalities, such as not enough testosterone.
Drug Therapy
Drugs for treating ED can be taken orally, injected directly into the
penis, or inserted into the urethra at the tip of the penis. In March
1998, the Food and Drug Administration (FDA) approved Viagra, the first
pill to treat ED. Since that time, vardenafil hydrochloride (Levitra)
and tadalafil (Cialis) have also been approved. Additional oral
medicines are being tested for safety and effectiveness.
Viagra, Levitra, and Cialis all belong to a class
of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before
sexual activity, these drugs work by enhancing the effects of nitric
oxide, a chemical that relaxes smooth muscles in the penis during sexual
stimulation and allows increased blood flow.
While oral medicines improve the response to sexual
stimulation, they do not trigger an automatic erection as injections do.
Points to Remember:
● Erectile dysfunction (ED) is the repeated
inability to get or keep an erection firm enough for sexual intercourse.
● ED affects 15 to 30 million American men.
● ED usually has a physical cause.
● ED is treatable at all ages.
Treatments include psychotherapy, drug therapy,
vacuum devices, and surgery.
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