Managed care and sexual dysfunction. Based on a presentation by William Parham, MD.

Abstract

The availability of managed care benefits for the treatment of sexual dysfunction is inextricably linked with cost. An atypically low increase of 4.4% in aggregate healthcare expenditures in 1995-1996 stands in sharp contrast to outlays of more than 11% between 1966 and 1993. Between 1993 and 1996, that increase hovered at about 5%, the result largely of the growth of managed care and low levels of general inflation. However, despite relative containment of overall healthcare expenditures, those related to pharmaceuticals have risen more than 9.2% annually, an increase that reflects the managed care industry's failure to restrain drug costs. In deciding whether it will cover a particular treatment, the managed care industry applies three sets of criteria relating to efficacy, medical necessity, and appropriateness. Managed care companies are expected to counter runaway pharmacy costs for sildenafil by excluding it from coverage, imposing significant limitations, or requiring higher copayments.