Forget Layoffs, Milwaukee Teachers Want Viagra
26 CommentsBy Ed Silverman // August 6th, 2010 // 8:50 am
How’s this for a budget battle? With all of the economic pain around the country, the Milwaukee teachers union has chosen an interesting issue over which to draw a line in the sand - they want a judge to order the school board to reinstate Viagra and other impotence pills in their health insurance plans. Never mind a financial crisis that may cause hundreds of union members to lose their jobs.
The filing is the latest in a two-year legal campaign in which the union has argued, so far unsuccessfully, that the board’s policy of excluding impotence pills discriminates against male employees, the Associated Press writes. The union says Viagra, Cialis, Levitra and others are necessary treatment for “an exclusively gender-related condition,” and filed a lawsuit that was lost but is now on appeal. In one brief, they noted vaginal cream, anti-bacterial medicine and estrogen replacement meds for female sexual dysfunction are covered.
Not surprisingly, school board lawyers say the drugs were excluded in 2005 to save money - more than 1,000 prescriptions were written the year before - and there is no discrimination because the pills are used mostly for recreational sex and not out of medical necessity. The recent union filing comes as the Milwaukee Teachers’ Education Association also protests hundreds of layoff notices issued to teachers for the coming school year. Citing a “financial crisis” caused by exploding benefit costs and revenue shortfalls, the district’s outgoing superintendent proposed laying off 682 employees in April.
At least one lawmaker questioned why the union is fighting for Viagra while teachers are losing their jobs. A school board consultant estimated that reinstating the benefit would cost $786,000 per year — the cost to keep perhaps a dozen first-year teachers employed. “You’ve got to be kidding me,” Milwaukee Democrat Jason Fields tells the AP. “The fact that is the point of contention is kind of frightening. What are our priorities? I’m all for love and peace. But almost $1 million? And you go to court over this issue?”
A union spokeswoman declined comment, but union lawyer Barbara Quindel says the case was worth fighting despite the grim finances. She argues erectile dysfunction is associated with heart disease, prostate cancer and other conditions, and the drugs are recommended by the American Urological Association. “MTEA believes that men should not be discriminated against in receiving treatment for their medical conditions,” she tells the AP.
The union maintains the costs are tiny compared to the $1.3 billion annual budget, but the board says they are “particularly burdensome” when it is under pressure to reduce benefit costs. Basic state employee health plans also generally don’t cover those drugs, but more expensive premium plans might, said Dick Cauchi, who tracks health benefits at the National Conference of State Legislatures. Lisa Soronen, National School Boards Association senior staff attorney, also said she had never heard of a similar case or an example of a union negotiating coverage for erectile dysfunction drugs. But what do you think?
Should Teacher Benefits Include Viagra & Other Impotence Pills?
- No (77%, 104 Votes)
- Yes (23%, 31 Votes)
Total Voters: 135
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Stephany
I’ve heard of teachers fighting for birth control pills to be reinstated to insurance coverage, which could lend to some similar discussion over why the pill is needed.
Birth control pills for women are often used to regulate cycles, hormonal imbalance and for Polycystic Ovary Syndrome.
The % of males needing the Viagra for medical not recreational use are the ones the case represents, therefore that is discrimination.
The birth control pills in the case I am familiar with, were in fact reinstated for coverage via the lawsuit.
pharmavet
I sympathize with the union. Being a teacher these days is enough to kill anyone’s sex drive.
Stephany
Without the union most teachers wouldn’t have a contract. Even at that, yes, pay is low, the job still rewarding!
Justice in MI
I’m surprised at the number of “no” votes. ED is definitely a medical condition for some number of men, regardless of its “off-label” uses. This guy is getting the short end of the stick.
Ed Silverman
Hi JiM,
Yes, there has been a rather limp response, so far, from those who might somehow get a lift from the pills. But the voting has just begun.
Cheers,
ed
pharmavet
JiM, it seems like every man has a right to a sex life whether or not he can afford ED drugs. I’ve covered a number of state Medicaid formulary meetings where it is customary to approve Viagra for 6-10 tablets/month. At retail prices this would cost the state over $1000/year/Medicaid patient on Viagra. This could easily cover a patient on a generic ACE Inhibitor for congestive heart failure for one year, not to mention that Medicaid itself is going broke. But then again, who can figure out why the government does what it does.
JaT
It might keep falling but it’s not falling off.
Imagine the headlines if they win Viagra for male teachers and then a couple boneheads have inappropriate contact with their students. Or if a student even just accused a teacher.
“Being a teacher these days is enough to kill anyone’s sex drive.”
:D
madpharm
Wisconsin Medicaid does not pay for Viagra or any other ED drugs. Wisconsin State employee’s health benefit also does not pay for ED drugs. Viagra, medically necessary? Not if your drugs are paid by Wisconsin taxpayers.
M. Black
The proper mix of certain vitamin and certain herbals are sufficient. When on an ad saying “if you have heart problems” make other people use it and then the heart problems CAUSED by the drug begin. In a court, a nonsensible finger-pointing session ensues for months and years.
Risks are written by cowardly pigs, saying what they say (because everyone is expected to have the capacity to read and digest the poster sized / miniscule print that people with AVERAGE eye capacity / brain capacity.
While the cowardly basters bask in the sun on their yacht.
~ M. Black
Reality Check
Pharmavet and Madpharm, you should be comforted to know that neither Medicaid programs nor Medicare Part D cover ED drugs. A federal law prohibiting such coverage came into effect in 2007.
mavnick
I think the unions have a limp case here. To sacrifice 10-12 first year teachers just to be able to rise to the occasion seems very selfish. They should be more concerned with weeding out bad teachers that have given the education system a black eye. I can’t wait to hear their flacid arguments in court. Washington DC superintendent has the right idea of axing the poor performers at the risk of losing her own job.
Justice in MI
Well, a good deal of the argumentation here is not tumescent, but at least the puns are hard on.
On the other hand…is Latisse covered? (wink, wink)
pharmavet
If Medicaid formularies no longer allow Viagra, maybe that will help them stay solvent. At one point shortly after Viagra came on the market, New Jersey was spending up to $483,000/month on Viagra alone.
MsPiggy
It appears this union is wanking up the wrong tree with this ever rising investment in something with such little returns…didn’t their mother’s tell them they can go blind taking this stuff…
M Helm, MD
I used to have to deal with this very issue on a somewhat routine basis… It was my responsibility to explain why ED medications were not covered by a health plan client. It is surprisingly easy to understand. These medicines are expensive and do not treat a condition which is life-threatening or associated with any real economic consequences.
A couple of years ago, the meds cost about $15 per pill, not sure what they cost now. Given competition in the marketplace, and general lack of insurance coverage, it is not likely to be very different now. Whatever the current cost, they are probably still less costly than movie tickets for two (with a concession stand trip), or a nice dinner at a good restaurant, or even an evening mingling at a bar. Most single (and a good number of married) men would consider these expenses a “cost of doing business.” Why is there an expectation that those with ED should receive a “subsidy” (if you will)?
Many (savvy) plans also restrict coverage of Retin-A, to prevent paying for it’s use to treat wrinkles. Can’t really imagine any reasonably well-run plans providing coverage for topical minoxidil shampoo or Propecia - though it is undeniable that cerrtain types of baldness are genetic disorders.
PEG
This is ridiculous and absurd considering the real issues teachers face in Milwaukee and throughout the country…their jobs!
These teachers need a reality check.
Reality Check
M Helm, Nice rationale for not paying for something–”expensive and do not treat a condition which is life-threatening or associated with any real economic consequences.” Treating my mild to moderate osteoarthritis pain would seemingly fall into the same category–it’s not a life-threatening condition and has no economic impact. I guess that means it doesn’t count in your eyes. No wonder you don’t treat patients!
By the way, if independent sources are to be believed, a majority of beneficiaries of employer-sponsored drug benefits do have some coverage for ED drugs, typically 4 to 6 pills per month at a 3rd tier co-pay (often $30-$45 or so).
M Helm, MD
RC, I think you are mistaken. OA pain can have real economic consequences. Ask anyone in a construction trade, or anyone who has to stand much of the time or do repetitive lifting.
Wrinkles, short eyelashes, acne, keratosis pilaris, “age spots”, baldness (or excess hair), unhappiness with your God-given physical attributes (which are within normal limits of form and function), and yes, capacity for intercourse - not so much of an economic consequence outside of very limited number of “professions” - some of which are illegal in many jurisdictions, and certainly not the only employment options. Yet for all of the conditions (and others) we have “medical” treatments.
You don’t have to like the rationale, but that doesn’t make it invalid. I’d rather health plans be able to afford coverage for folks with MS, Hep C, CHF, diabetes, asthma, etc. than to transfer the burdens and costs of a limited number of people onto a larger group for something which is clearly optional. There is a lot of confusion about “necessary” and “optional” or “discretionary” when it comes to spending other people’s money. There is even confusion about these issues in self-insured plans where rather than spending “other people’s” money, it should actually be seen as “our” money.
Would the union endorse the same coverage if they were given a fixed trust fund from which they had to cover all of their member’s current and future needs?
Your point about many employer-sponsored plans providing coverage fails to consider that most plans simply take the recommendations of their PBMs or consultants. The PBMs and consultants typically make more money as the plans spend more on medications. Since brand manufacturers offer “rebates” (a portion of which stay with the PBM and/or consultant)on ED products, it is not in the interest of the PBM to recommend that these medications not be covered. This reveals a fundamental flaw (or at least an inherit conflict of interest) in the current market structure for pharmacy benefits. It is also a contributing cause of “business as usual” resulting in unsustainable growth of pharmacy benefit costs for self-insured plans.
pharmavet
Osteoarthritis and ED are apples and oranges as far as cost goes. Viagra today retails for around $25/tablet. The same $25 will buy you 750-1000 store brand 500 mg capsules of extra strength strength Tylenol for osteoarthritis. Throw in another $20 for 120 tabs of naprosyn, and osteoarthritis is a relatively low cost disease to treat.
Reality Check
Helm,
The majority of the people who suffer from OA are retired, so your economic argument doesn’t hold. Also, as a managed care physician (is that an oxymoron), why not deny coverage for any prescription product and mandate self-payment for OTC NSAIDs. Screw’em if it doesn’t work or if they get bleeding ulcers. If you work at a Part D plan, who cares, Medicare Parts A and B will pay–right?
Vet, by the way, you must be getting ripped off by your pharmacy–mine charges only $17.50 a tablet.
pharmavet
Thanks, Reality Check. I was ballparking on the price of Viagra based on internet pharmacy prices, since I’ve never actually had a prescription filled for the stuff. Hopefully by the time I need it, the product will be generic (earliest patent expires 2012).
M Helm, MD
RC,
I suppose that SOME consultants would recommend the approach you suggest. I would not. I know of some plans which don’t cover antihistamines because they can be purchased without a prescription. This is a bad idea - it creates increased demand for less-effective and potentially more expensive prescription alternatives (which perversely works out fine for most consultants and PBMs). Same would be true for NSAIDS. I advocate a very different approach, but one which actually produces better long-term (fiscal and health) results.
I am a physician, but I started with an MBA, and worked in PhRMA for about a decade prior to medical school. I am both a clinician and a business conusltant - not really a “managed care physician.” However, if there weren’t MDs in insurance and managed care companies, who would provide advice and help make or review decisions regarding coverage policy (for example determining what is appropriate care versus quackery, etc.)?
As for OA being only a problem in Medicare, that’s not true - the majority of persons with OA have it before age 65. Now it may be true that most people on Medicare suffer from OA, but that’s not the same thing.
I don’t currently work with any Part D plans - my focus is self-insured employer-sponsored plans. Part D plans have an entirely different set of problems, not the least of which is that they are not managed to minimize total health costs - which was (I believe) exactly your point.
Pharmavet is correct that ED and NSAIDs are a poor comparison, but it is difficult these days to come up with a crowded medication category with no generic compounds offering similar treatment effects. The closest analogy may be anti-TNF agents for RA. But for a number of (mostly boring or arcane) reasons even this is a poor comparison.
Justice in MI
So what are the odds that the policy will change when the relevant meds are available as generics?
Pat
Fearing a return to sexual duty, wives of Milwaukee teachers union urges court to deny Viagra claim
MADISON, Wis. – A coalition of wives of the Milwaukee Teachers Education Association (MTEA) has filed an amicus curiae in the ridiculous civil suit brought by the MTEA against the Milwaukee School District (MSD). In the suit, the MTEA makes the heinous claim that a recreational lifestyle drug should come before the employment of some its own members.
But the wives aren’t entering the fray over any concern for the proletariat downtrodden. Instead, they fear that arousing their husbands from their slumber of impotence could mark an end to a period of blissfully platonic inactivity that began in 2005 when an arbitrator agreed that MPS didn’t have to provide free Viagra to the union …
http://wineandexcrement.com/fearing-a-return-to-sexual-duty-wives-of-milwaukee-teachers-union-urges-court-to-deny-viagra-claim/2337/
likeitis
Being teachers does not seem to kill their sense of humor ;-)
pharmavet
No wonder the men are impotent. I once dated several women from Wisconsin who looked like they could try out for the Green Bay Packers. The men were no prizes either. Must be the Wisconsin ice cream, which has a higher butterfat content than most others, hence tastes great.