By Mike Causey
Washington Post Staff Writer
Wednesday, April 29, 1998; Page B02

Will taxpayers be required to pay part of the cost of prescriptions for Viagra -- the new anti-impotence drug -- which could be used by many male federal workers and retirees?

The answer for certain employees in certain federal health plans is probably yes!

Most health maintenance organizations now cover drugs and treatments for sexual dysfunction or impotence. About 40 percent of the 2.6 million members of the federal work force are enrolled in an HMO. But most fee-for-service plans -- which include nationwide giants such as Blue Cross -- have contract language that specifically excludes paying for such treatments.

Top officials who oversee the giant federal health program are studying what one yesterday called "the Viagra phenomenon." Industry specialists expect the government will come out with a statement directly related to this issue this summer while it renegotiates premiums -- and coverage -- with health plans for 1999. There are more than 300 plans in the federal program, including about 20 in the Washington area.

By law, government pays about 72 cents of each federal health premium dollar. The federal employee health program is the nation's largest. It covers more than 10 million people -- current and former workers, spouses and ex-spouses, dependents and grandchildren -- including about half the people in this area.

When he broke his foot several years ago, Vice President Gore's treatment was paid for, in part, by his health plan, BACE (Beneficial Association of Congressional Employees), which is part of the federal health program. One of the first heart transplants in the United States was paid for by a union-sponsored health plan that was then part of the program.

Since the Food and Drug Administration approved the drug, Viagra fever has swept the nation. Doctors and clinics are swamped with calls for prescriptions for pills that cost about $10 each.

On April 9, this column reported that the Office of Personnel Management -- which runs the federal health program -- had told plans they couldn't refuse to pay for treatments or procedures they considered experimental if those treatments had been approved by the FDA. The notice went to health plans, not policyholders. Most of them read it here.

The notice said in part: "When the FDA has approved a drug, device or biological product, all [federal health] plans must provide coverage when the product is used for its intended purposes and labeled indications, as approved by FDA, if those purposes and indications would otherwise be eligible for benefits under the plan's benefit structure. . . . As with all other covered benefits, the services must be medically necessary and appropriate."

Federal officials, and health insurance specialists, said that the OPM policy was designed to make sure health plans follow uniform procedures but that it does not make any changes in a plan's contract, which spells out what services it will -- and won't -- cover.

Generally speaking, fee-for-service contracts contain consistent language on this subject. They say that "benefits will not be paid for services and supplies for or related to sex transformation, sexual disfunction or sexual inadequacy." Federal officials say that HMOs in the program are often more liberal on the subject and that many HMOs do cover services, and drugs, related to impotence.

In the meantime, if you are a federal worker or retiree anxious to get help paying for Viagra, check the fine print of your health plan contract. And hope that insurance negotiators -- when they are bargaining this summer -- will keep this new development in mind for 1999.