Women protest as US men get Viagra on medical insurance

Cost of the contraceptive Pill rankles, reports Mary Dejevsky in Washington

THREE weeks after the little blue pill went on to the market, it emerges that men in United States who have obtained the impotence drug on prescription have a 50:50 chance of persuading their health insurance company to pay for it. Women, on the other hand, who are prescribed the contraceptive Pill, must usually pay for it themselves.

This has been seized on by women's groups as a discrepancy amounting to sexual discrimination. If insurance companies pay for men's Viagra, why not the Pill for women? Their irritation is all the greater because of proliferating reports that doctors are prescribing Viagra not just for clinical impotence, but for what is euphemistically called "enhancement".

One doctors' group, the American College of Obstetricians and Gynecologists, which has a larger proportion of female members than most US medical organisations, is now lobbying Congress to pass legislation requiring insurers who pay for prescription drugs as a matter of course, also to cover the Pill. Insurance companies, the group's spokesman said, were demonstrating "a clear bias".

The insurance companies offer two arguments: cost and need. The costs, they say, are not comparable: the contraceptive pill is used by millions of women for decades at a time, while the current rate of Viagra prescriptions is running at 300,000 a week. Insurance companies are also limiting the number of Viagra pills they will pay for, to between four and 10 a month. Even with the Pill costing between $20-30 (pounds 12.50-18.75) a month, and Viagra costing between 10 and 12 dollars per tablet, the total cost to the insurance company of covering the Pill will be far more than covering Viagra. The College of Obstetricians responds by citing the costs of unwanted pregnancies.

The insurance companies also argue that impotence is a clinical condition, while the decision to use contraception is elective - an argument which has the full sympathy of the anti-abortion lobby.

The apparent discrepancy in the treatment of men and women also derives, in part, from the US health system, which is mostly private and employer- linked and regulated differently from state to state. Many insurance companies say they offer plans that cover all prescription drugs, including the Pill, but most companies do not select them on grounds of cost. This is an "employer decision", said a spokesman for the Health Insurance Association of America, not an "insurer decision". Six states mandate some reimbursement of contraception costs, but nine out of ten US women with insurance must pay.

The incipient women's revolt over Viagra could prompt a reassessment of contraceptive cover. But the likely result will be higher premiums for all.