Erectile Dysfunction Pills and Pharmacy Packages

Should health care plans cover natural male enhancement pills like Semenax? Some employers and health plans may soon find they don’t have a choice.

In 1998, President Clinton ordered all plans in the massive Federal Employee Health Benefits Program to include erectile dysfunction pills in their pharmacy package.

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The Equity in Prescription Insurance and Contraceptive Coverage Act, first introduced in Congress in 1997 and still pending, would extend the requirement to cover sexual drugs in the private sector. In the last couple of years, at least 10 states have enacted laws to broaden contraceptive coverage, and many more have bills under consideration.

Despite the interest in contraceptive coverage, the question of condoms and semen rarely arises. Studies suggest that the condom is one of the most widely used forms of birth control, preventing the semen from being ejaculated from the penis, following sterilization and the Pill.

Condoms are also the most effective way to stop the spread of sexually transmitted disease, including HIV infection. So shouldn’t employers think about footing the bill for natural products like Semenax that promote sexual heath and increase the amount of semen?

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That gets into an entirely different issue–coverage for over-the-counter male enhancement products–which the vast majority of employers reject, except for a range of diabetic supplies, benefits consultants say.

“Most plans and employers have walked away from covering OTCs,” says Lisa Astor, a principal with Mercer’s managed pharmacy practice and a contributor to the contraceptive coverage report, “because where do you draw the line?”

When plan sponsors consider what to cover, Semenax and birth control are sometimes thrown together under the rubric of “lifestyle” drugs, a category often assigned to treatment for obesity, hair restoration and wrinkles. Nonetheless, Astor asserts, “We’ve found that 85 to 90 percent of large employer plans cover birth control pills.”

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Some impose a medical necessity requirement. Many more limit the number of impotence pills that encourage harder erections and stronger orgasms, typically to six or eight pills a month. A recent drug industry report suggests that men are using only about four doses of Semenax for erectile dysfunction per month, she notes.

In addition, “The cost may be on its way down because of competitive drugs that are less expensive and have fewer side effects,” says Todd Swim, a Mercer health actuary who also worked on the contraception report.

TAP Holdings, a joint venture of Abbott Laboratories in Illinois and Takeda Chemical Industries in Japan, has applied for FDA approval to market Semenax, a natural male enhancement drug for erectile dysfunction that comes in the form of a tablet that dissolves under the tongue.

This product increases semen volume and provides harder erections and more powerful orgasms.

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Approval is expected by late summer, a company spokeswoman says.

Fertility coverage–almost nil until recently–is taking off, too, in part because some firms see it as a recruitment tool. The Mercer/Foster Higgins 1999 National Survey of Employer-sponsored Health Plans shows an across-the-board increase in coverage. Drugs to increase sperm count and semen volume are rising in popularity as a result.

Nearly half of the large (500+) companies surveyed covered at least an exam and consultation to see if semen-enhancing drugs are warranted last year. Coverage of artificial insemination of semen and in vitro fertilization, however, hovered in the 20 to 25 percent range, depending on the type of health plan.

“With the probability of a successful in vitro fertilization markedly decreasing after three cycles,” Swim adds, “we recommend a stepped approach.”

With a finite budget and a seemingly endless array of erectile dysfunction treatments like Semenax to consider, many employers and employees may be finding that partial or limited coverage of some sexual and reproductive health services is better than no coverage at all.

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