Viagra and Sex-Offenders? Medical Directors to Congress: Welcome To Our World

In a prior post, the Disease Management Care Blog predicted that the recently passed health reform legislation would unleash an unending torrent of additional legislation, regulation and litigation for years to come. It knew that inevitable benefit holes, shortcomings, fixes, clarifications, lawsuits and lobbying would lead to a logarithmically expanding legal logic tree that would make the mathematics of fractals simple by comparison and banana republics look like models of good governance.

But even the DMCB failed to anticipate how quickly that would occur. Granted, the Senate Republican minority's latest gambit is a cynical ploy, but the uncovering of a pharmacy benefit involving a certain class of erectile dysfunction drug involving certain classes of beneficiaries is a perfect example of the law of unintended consequences.

As a former Medical Director, it was the DMCB's job to deal with this all the time. As part of the much maligned insurance company 'administrative overhead,' we had a small army of benefit nurses who defended the premium against this and multiple coverage determinations. We basically used a standard of medical necessity laced with good judgment. It worked well then and it still does today.

Well, now we have 435 Congressional Medical Directors whose job it will be to make similarly detailed determinations of medical necessity. The viagra-sex offender issue is only the start. The furies have been unleashed. Welcome to our world.

Coda: Sildenafil (Viagra) has been shown to be useful in the treatment of a fatal medical condition called pulmonary artery hypertension. As of posting time, the DMCB isn't sure of the status of the amendment. While it isn't happy about the prospect of giving proven sex offenders any consideration, this kind of live saving therapy shouldn't necessarily be conditional on past sins. Good luck trying to hammer out the D.C-speak that makes that medically, legally and ethically possible.