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Spending on Viagra for veterans nearly triples

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Bloomberg News
WASHINGTON -- The U.S. Department of Veterans Affairs has almost tripled spending on erectile dysfunction drugs in the past six years as war-related psychological disorders contribute to sexual difficulties.
The VA spent $71.7 million on drugs including Pfizer's Viagra and Bayer's Levitra in the year ended Sept. 30, up from about $27.1 million in fiscal 2006.
The surge in drug spending reflects the number of troops returning from wars in Iraq and Afghanistan with issues such as post-traumatic stress disorder and depression, said Jason Hansman, senior program manager for health and mental health programs at the Iraq and Afghanistan Veterans of America, a New York-based nonprofit group. Both conditions can limit sexual functioning, he said.
"This is not something that a lot of veterans would readily talk about," said Hansman. "It's a very good sign that the VA is paying out and not trying to avoid the issue in any way. Sexual health is part of the holistic picture of health for veterans."
Veterans are eligible for free medications and treatment for any injuries or illnesses linked to their military service. Even if there's no connection to their time in uniform, they may still obtain drugs through the VA for a fee that is typically less than $10 for a 30-day-prescription, according to the documents posted on the agency's website.
Monthly prescriptions for erectile dysfunction medications almost doubled to 4.5 million in fiscal 2012 from 2.7 million in fiscal 2006, according to VA data. Also bought were Indianapolis-based Eli Lilly's Cialis and the drug alprostadil, used in several brand-name and generic medications.
The department's pharmaceutical spending with San Francisco-based McKesson Corp., which has a contract to supply most of the VA's drugs, rose 22 percent to $4.29 billion from $3.51 billion during the same time period, according to data compiled by Bloomberg.
Meagan Lutz, a VA spokeswoman, didn't comment about the reasons behind the increase in erectile dysfunction drug spending or prescriptions.
A study published last year in the Journal of Sexual Medicine echoed earlier reports that have showed veterans that suffer from post-traumatic stress disorder, or PTSD, were more likely to have erectile dysfunction.
More than 250,000 of Iraq and Afghanistan veterans sought care for potential PTSD from October 2001 through June 2012 at VA facilities, according to a departmental report posted online.
The Journal of Sexual Medicine study showed some recent war veterans were receiving the erectile dysfunction medicine without clear medical diagnoses. An analysis of agency data on 4,755 Iraq and Afghanistan veterans who sought treatment at a VA clinic in Houston showed a "marked discrepancy" between diagnosed erectile dysfunction and prescriptions of medicine for the disorder, according to the report.
That's not necessarily a cause for concern, said Drew Helmer, a medical doctor who worked on the research and is director of the VA's War Related Illness and Injury Study Center in East Orange, N.J.
"Sometimes, people are shy about putting things in the medical record," Helmer said in a phone interview. "Sexual function is an awkward topic for a lot of doctors and patients."
The review was prompted by a VA doctor who noticed many younger veterans were requesting the erectile dysfunction medication, which is typically sought by older men, said David Latini, an assistant professor of urology at Baylor College of Medicine in Houston. The researchers knew beforehand that post- traumatic stress disorder and other psychological trauma could result in sexual problems, said Latini, who worked on the study.
"In many cases, just like in private practice, men are given a prescription because they're having a difficult time and they ask for it," Latini said in a phone interview. "The doctor says, 'Let's give it a try and see if it helps,' without a diagnosis."
The researchers' work is beginning to show a need for more comprehensive sexual diagnoses before prescriptions are written, he said.
The VA needs to do more to ensure female veterans receive equal treatment for sexual dysfunction, said Rep. Chellie Pingree, D-Maine.
"Many of the issues around female sexual dysfunction are largely unrecognized, and it's difficult to get assistance," Pingree said.
There is no VA diagnostic code for female sexual arousal disorder, which has resulted in women having sexual dysfunction claims denied, she said.
Pingree wrote a letter last month to Allison Hickey, the VA's undersecretary for benefits, asking her to consider increasing benefits for women veterans who suffer sexual arousal disorder after military service-related injuries.
"If you look at this as a parity issue, males are being treated in numbers that are going up, and women with similar kinds of issues deserve equal access to care," Pingree said.

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