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Viagra User Sues Insurance Co.

A major health insurance company has been sued by one of its policy holders for not covering Pfizer Inc.'s impotence drug, Viagra.

In a lawsuit aimed at making the popular drug as recognizable to employer health insurance companies as any other drug, the plaintiffs named Oxford Health Plans Inc. of Trumbull, Conn., as a defendant along with "John Doe insurance companies or corporations." The lawsuit estimated the potential class of plaintiffs at greater than 1 million.

Since the Food and Drug Administration approved the drug March 27, more than 1 million men may have been unfairly denied reimbursement by health insurance companies, the lawsuit alleged.

The lead plaintiff was Paul Sibley-Schreiber, a Manhattan diabetic whose medical problems led to impotence and a doctor's prescription for the Pfizer Inc. drug.

The lawsuit alleges that since the FDA approved the impotency drug Viagra, insurance companies, in a move to save money, have publicly signaled one another to restrict reimbursement for the drug.

Sibley-Schreiber said he sought reimbursement from Oxford and was denied on May 1, even though the company promises to cover all prescription drugs that are medically necessary.

The lawsuit said Oxford told Sibley-Schreiber that all claims for insurance coverage for Viagra will be denied until at least mid-June.

The lawsuit says as many as 100,000 prescriptions for Viagra are being written each week and only 51 percent of patients are being reimbursed by their insurance companies, compared to an average 76 percent coverage rate for prescription drugs overall. Those are the companies being targeted by the lawsuit.

Lawyers representing Sibley-Schreiber said the suit, filed in the Eastern District of New York's federal court, may eventually be widened to include dozens of other insurance companies that have denied or restricted coverage of the drug.