Lifestyle

The High Cost Of Sex: Insurers Often Don’t Pay For Drugs To Treat Problems

For some older folks, the enjoyment of intercourse could also be tempered by monetary issues: Can they afford the medicines they should enhance their expertise between the sheets?

Medicare and lots of personal insurers don’t cowl medication which can be prescribed to deal with issues folks have participating in intercourse. Recent developments, together with the approval of generic variations of widespread medication Viagra and Cialis, assist customers afford the remedies. Still, for many individuals, paying for expensive medicines could also be their solely possibility.

At 68, like many postmenopausal ladies, Kris Wieland, of Plano, Texas, experiences vaginal dryness that may make intercourse painful. Her signs are amplified by Sjogren’s syndrome, an immune system dysfunction that usually causes dry eyes and mouth, and might have an effect on different tissues.

Kris Wieland (left) of Plano, Texas, pictured with daughter Anne, was denied protection by her Medicare Part D plan for a drug that replenishes vaginal estrogen, prescribed by her physician.(Courtesy of Kris Wieland)

Before Wieland turned eligible for Medicare, her gynecologist prescribed Vagifem, a suppository that replenishes vaginal estrogen, a hormone that declines throughout menopause. That enabled her to have intercourse with out ache. Her husband’s employer plan lined the remedy, and her copayment was about $100 each different month.

However, after she enrolled in Medicare, her Part D plan denied protection for the drug.

“I find it very discriminatory that they will not pay for any medication that will enable you to have sexual activity,” Wieland mentioned. She plans to enchantment.

Under the legislation, medication used to deal with erectile or sexual dysfunction are excluded from Part D coverage until they’re used as a part of a remedy accepted by the Food and Drug Administration for a distinct situation. Private insurers typically take the same strategy, reasoning that medication to deal with sexual dysfunction are lifestyle-related slightly than medically vital, in response to Brian Marcotte, CEO of the National Business Group on Health, which represents giant employers.

So, for instance, Medicare could pay if somebody is prescribed sildenafil, the generic title for Viagra and one other branded drug known as Revatio, to deal with pulmonary arterial hypertension, a sort of hypertension within the lungs. But it usually received’t cowl the identical drug if prescribed for erectile dysfunction.

Women like Kris Wieland could encounter the same drawback. A wide range of lotions, suppositories and hormonal rings enhance vaginal estrogen after menopause so that ladies can have intercourse with out ache. But medication which can be prescribed to deal with that drawback haven’t typically been lined by Medicare.

Sexual-medicine specialists say such exclusions are unreasonable.

“Sexual dysfunction is not just a lifestyle issue,” mentioned Sheryl Kingsberg, a medical psychologist who’s the chief of behavioral drugs at University Hospitals MacDonald Women’s Hospital in Cleveland. She is the rapid previous president of the North American Menopause Society, a company for professionals who deal with ladies with these issues. “For women, this is about postmenopausal symptoms.”

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Relief could also be in sight for some ladies. Last spring, the federal Centers for Medicare & Medicaid Services despatched steering to Part D plans that they may cowl medication to deal with average to extreme “dyspareunia,” or painful intercourse, attributable to menopause. Plans aren’t required to supply this protection, however they could accomplish that, in response to CMS officers.

The North American Menopause Society applauded the change.

“Dyspareunia is a medical symptom associated with the loss of estrogen,” mentioned Kingsberg. “They had associated it with sexual dysfunction, but it’s a menopause-related issue.”

For males that suffer from erectile dysfunction, remedy can confer each bodily and emotional advantages, in response to specialists in sexual well being.

“In my clinical work, I see a lot of older couples,” mentioned Sandra Lindholm, a medical psychologist and intercourse therapist who can also be a nurse practitioner in Walnut Creek, Calif. “They are very interested in sex, and they feel like they’re able to embrace their erotic lives. But there may be medical issues that need to be addressed.”

Roughly 40 percent of men over age 40 have problem getting or sustaining an erection, research present, and the issue will increase with age. An identical share of postmenopausal ladies expertise genitourinary syndrome of menopause, a time period used to explain a number of signs associated to declining ranges of estrogen, together with vaginal dryness, itching, soreness and ache throughout intercourse, in addition to elevated danger of urinary tract infections.

Low sexual need is one other frequent criticism amongst ladies and men. A drug called Addyi was accepted in 2015 to deal with low sexual need dysfunction in premenopausal ladies. But many insurers don’t cowl it.

Unfortunately, medicines that deal with these situations could price folks a whole bunch of a month if their insurance coverage doesn’t choose up any of the tab. A 10-tablet prescription for Viagra in a typical 50-milligram dose may cost more than $600, for instance, whereas the value of eight Vagifem tablets could exceed $200, in response to GoodRx, a web site that publishes present drug costs and reductions.

In current years, rather more inexpensive generic variations of a few of these medicines have gone in the marketplace.

Generic variations of Viagra and Cialis, one other widespread erectile dysfunction drug, could also be obtainable for only a few a capsule.

“I never write a prescription for Viagra anymore,” mentioned Dr. Elizabeth Kavaler, a urogynecologist at Lenox Hill Hospital in New York City. “These generics are inexpensive solutions for men.”

There are generic variations of some ladies’s merchandise as nicely, together with yuvafem vaginal inserts and estradiol vaginal cream.

But even these generic choices are sometimes comparatively expensive. Some sufferers can’t afford $100 for a tube of generic estradiol vaginal cream, mentioned Dr. Mary Jane Minkin, a medical professor of obstetrics, gynecology and reproductive drugs at Yale University School of Medicine.

“I’ve asked, ‘Did you try any of the creams?’ And they say they used up the sample I gave them. But they didn’t buy the prescription because it was too expensive.”

Michelle Andrews: andrews.khn@gmail.com”>andrews.khn@gmail.com, @mandrews110

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