NEW YORK -- Four Viagra pills a month just doesn't cut it for David Scholl. So last fall he sued his health plan, QualMed, to get it to pay for more of the anti-impotence drug.
"Nine dollars a pill is expensive," said Scholl, a federal judge in Philadelphia. "And there's something about having to pay to have sex that doesn't seem quite right. At least not to pay that much."Scholl, 54, is one of a small, but growing number of American men suing their health insurers for denying or restricting coverage of the Viagra pill.
Most of the largest health maintenance organizations have been sued over their Viagra policies, including Aetna, Humana, Prudential and Kaiser Permanente. While none of the cases has yet to go to trial, judges have usually let the suits proceed over the HMO objections.
In one of the biggest cases, a federal judge in California last month refused Aetna's motion to dismiss a class-action suit that seeks to represent men across the country.
Legal experts say there's more at stake than just Viagra coverage. The cases will help determine whether insurance should pay for so-called "lifestyle" treatments that may not be medically necessary.
About 8 million prescriptions for Viagra have been written for more than 4 million men since the breakthrough treatment hit the market a year ago. But Viagra's cost of $9 to $10 a pill and high demand worries some insurers which are struggling with rising medical costs.
Some health plans, such as Humana and Prudential say their decision not to cover Viagra was based on concerns about its safety. The drug is dangerous when taken by those who also take certain heart drugs such as nitroglycerin. Some older men have died from heart attacks after resuming long dormant sexual lives, although Viagra has not been definitively linked to their deaths.
However, Wall Street analysts presume the real reason insurers won't cover the drug is they're looking to cut costs.