Insurance won’t pay for women to have pleasurable sex
Michelle Weber says that when her boyfriend wanted to take Viagra, his insurance paid for it, no questions asked.
So when she wanted to take the new “female Viagra” for her sexual problems, she figured that would go smoothly, as well.
But it didn’t.
Her insurance company refused to pay for the drug, called Addyi, saying she’d have to see a psychiatrist first.
“They don’t tell men who want Viagra that they have to see a psychiatrist,” said Weber, 38, who asked that her real name not be used, in order to protect her and her boyfriend’s privacy.
Indeed, they don’t, say doctors who treat sexual dysfunction.
And these doctors say the psychiatrist requirement is just one of many “barriers” that insurance companies have put in place for women, but not men, who are seeking drugs to treat sexual problems.
“It’s a huge double standard,” said Weber’s gynecologist, Dr. Tami Rowen, an assistant professor of obstetrics and gynecology at the University of California-San Francisco.
Dr. Irwin Goldstein, a sexual health specialist in San Diego for both men and women, said insurance companies have routinely rejected his prescriptions for Addyi, but that’s never been the case for Viagra.
“It’s startling. It’s so sexist,” said Goldstein, the president of the International Society for the Study of Women’s Sexual Health, who has been a paid consultant to the pharmaceutical companies that make both Addyi and Viagra.
Three reasons company won’t pay for ‘female Viagra’
In addition to the psychiatrist requirement, Weber’s insurance company, Blue Shield of California, refuses to pay for Addyi unless a woman first tries another, less expensive drug, according to the company’s prescribing guidelines.
That less expensive drug isn’t approved to treat sexual problems and can have devastating side effects.
Blue Shield gave Weber a third reason it wouldn’t pay for Addyi, according to a letter it wrote her. The company said it wouldn’t pay because her low libido appeared to be a side effect of a medication she’s taking.
Weber said Blue Shield must have been referring to the only drug she takes: a type of antidepressant known to have sexual side effects for both men and women.
But she said she suffered from low libido even when she wasn’t on an antidepressant.
“And I’d love to know, do they tell men they can’t have Viagra because they’re on antidepressants?” she asked.
CNN sent Clinton McGue, a Blue Shield of California spokesman, an email with this question. He responded that “without knowledge of the member’s detailed history or the case,” he could not provide more of a response.
When asked about the Addyi denials, a spokeswoman for the insurance industry responded that some studies have shown Addyi isn’t very effective and can have side effects.
“If there’s a question mark around a coverage decision, that usually means there’s a question mark around the efficacy,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans. “This drug failed two FDA reviews prior to being approved, and the reason it got approved the third time is because of a broad PR campaign by the company that makes it.”
That explanation doesn’t sit well with doctors who treat sexual dysfunction. They say the FDA ruled last year that Addyi, which is taken every day, is safe and effective. The doctors add that the drug doesn’t work for all women, but it certainly works for some.
“I think women in general should be alarmed. Insurance companies are covering things for men that they’re not covering for women,” said Dr. Alyse Kelly-Jones, a gynecologist in North Carolina.
Doctors: Insurance refuses to pay for other female sex drugs, too
Doctors said the “double standard” they see for women with sexual problems manifests in other ways, too.
They said insurance typically pays for their older male patients to take testosterone to boost their sagging sex lives. But when older women want treatments for vaginal dryness and atrophy, insurance companies usually balk.
Krusing disagreed, saying major insurance companies do cover such treatments.
But gynecologists cite denial after denial for such drugs.
Dr. Laura Hirshbein, associate professor of psychiatry at the University of Michigan, said she’s dismayed but not surprised that insurance companies are often refusing to pay to treat women with sexual problems.
Hirshbein, who studies issues of gender, sex and psychiatry, said men with erectile dysfunction get a multitude of treatment options, which are often celebrated in giant advertising campaigns.
“Men get told they can expect to function sexually and can expect to easily get whatever they need in order to do that,” Hirshbein said.
But she said that historically, women have been told that if they have sexual problems, they must be mentally ill.
“Women are told it’s all in their head,” she added.
$1,000 a month to attempt pleasurable sex
In March, when Weber received her Addyi prescription from her gynecologist, she unsuspectingly headed to the pharmacy to fill it.
The pharmacist came back with the news: Her insurance company wouldn’t pay for it. She could pay for it herself — to the tune of $1,000 a month.
No, thank you, Weber said, and walked out empty-handed.
Blue Shield’s McGue said in a statement that “a committee of external pharmacists and physicians, including psychiatrists, review the medical evidence for prescription medication to determine Blue Shield’s coverage policy,” he wrote. “The committee determined that Hypoactive sexual desire disorder is best diagnosed after a psychiatric evaluation.”
But doctors said other specialists, such as gynecologists and sexual health experts, have the training and experience to identify and treat sexual problems, not psychiatrists.
“I’m a sexual health expert. This is my niche,” said Rowen, Weber’s gynecologist. “And they’re telling me I can’t diagnose a sexual disorder? That’s crazy.”
Hirshbein, the psychiatrist at the University of Michigan, agreed. She said that when her patients suffer from sexual dysfunction, she sends them to doctors who have more experience in that area.
“I’m a psychiatrist. I wouldn’t write a prescription for [Addyi], in the same way I wouldn’t write a prescription for Viagra,” she said.
The side effects of ‘female Viagra’
In his statement, McGue also mentioned “the serious safety concerns associated with Addyi [which] include adverse effects of the central nervous system.”
Addyi has a “black box warning” highlighting the increased risk of low blood pressure and fainting when combined with certain other drugs or with alcohol.
The less expensive drug that Blue Shield requires women try before taking Addyi has a black box warning of its own.
Bupropion, also known as Wellbutrin, has a warning highlighting the risk of developing “serious neuropsychiatric symptoms,” including suicidal thoughts.
“That makes no sense,” said Kelly-Jones, the gynecologist in North Carolina. “For Wellbutrin to be considered first-line therapy for something it’s not FDA-approved to treat, that’s concerning.”
Low libido taking a toll
Since getting the rejection from Blue Shield in March, Weber has been on a mission.
She did get a prescription from a psychiatrist and marched it into the pharmacy a few weeks ago.
The pharmacist came back with more news: Blue Shield had rejected it again, saying she needed more documentation from the psychiatrist.
Weber calls the whole situation ironic.
Her boyfriend doesn’t need Viagra, she says. He can have sex without it. He wants it so he can have longer-lasting erections, hoping that might make her happier.
“I’m the one with the actual disorder. I’m the one with no sex drive at all. But he’s the one who walks out of the doctor’s office with a prescription that he can actually fill,” she said.
As she tries to increase her libido — she sees a certified sexologist for help — she hopes her relationship will survive.
She explains to her boyfriend that she doesn’t know why she has a low libido, but she knows it has nothing to do with him or his sexual performance.
Even with the reassurances, she’s not sure their relationship will survive her lack of interest in sex.
“We’re thinking about getting married. It’s really serious. But a big piece of it isn’t working, and that’s hard for both of us,” she said.
By Elizabeth Cohen
Senior Medical Correspondent