Access to innovative treatment of erectile dysfunction: clinical, economic, and quality-of-life considerations

While effective therapies exist for health conditions that diminish the quality of life, there remain hurdles in healthcare delivery that may limit access to such therapies for individuals who would benefit from them. Limited company resources coupled with double-digit increases in pharmaceutical costs--frequently designated as the "culprit" behind recent increases in medical expenditures--may not allow health plans to cover every effective drug in every clinical circumstance for every affected individual. Managed care companies currently employ several mechanisms to counter runaway pharmaceutical costs, such as excluding some drugs from coverage, imposing significant limitations, or requiring higher copayments through tiered pharmaceutical coverage structures. The trend toward greater patient contribution for indicated agents could well invoke cries of bias, in that a tiered copayment system may discriminate based on income and ability to pay. The practical inability within the healthcare community to compare healthcare interventions such as treatments for erectile dysfunction with those for asthma, hypertension, or other conditions prevents the optimal allocation of healthcare services.