I have been prescribed Viagra by a urologist and my primary care physician. I am having trouble getting my insurance carrier to cover the cost of this prescription. Can you tell me if I am correct that last year the government somehow intervened on behalf of patient rights and mandated that insurance companies must cover the cost of Viagra just as they do any other prescription medicine? If this is correct, how can I get this information to my insurance company?

G.E.

You are incorrect about the government passing a law requiring coverage for Viagra. No such federal law has been passed, and I don't believe that the current health insurance reform bill under consideration in Washington includes such a benefit. The patient rights of which you speak are being debated, but they cover general items, such as continuity of care and emergency room availability, as opposed to specific prescription drugs. On the other hand, some states may be considering legislation mandating coverage of both prescription contraceptives and Viagra.

An Executive Order did mandate coverage for Viagra and prescription contraceptives under government plans, such as veteran's insurance and the Federal Employee Health Benefit Plan.

So your insurance company does not have to cover Viagra. In fact, insurance plans are not required to include prescription drug benefits at all. Just because you may have prescription drug benefits, that doesn't mean you have access to any and all pharmaceuticals. Even within prescription drug coverage, there are certain limitations. Some plans pay differently for generic and name-brand drugs. Some exclude payment for certain drugs altogether.

People today complain about many aspects of their insurance coverage. The most common complaint is the cost of insurance. Close behind this is a complaint that insurance doesn't include enough benefits. This is an interesting paradox, as many politicians and policymakers hear these complaints and try to do something about both. But it doesn't take long to understand that you cannot keep down the cost of insurance while adding mandated benefits to all health insurance plans.

The issue of cost is central to your question here. Gaining benefits for certain medical services can cost as much as or more than the service itself, especially when we're talking about something as relatively inexpensive as Viagra. It costs as much for an insurance company to process a small insurance claim as it does to process a large one, and that adds to the cost of coverage for that item. So you might be better off to pay for some of your medical services yourself, including the cost of Viagra.

Several things happen when the government starts mandating insurance benefits. First, the price goes up. That should come as no surprise to anyone, but it still does. It goes up for the same reason the price of a car increases when the government mandates airbags and other equipment. Second, people lose their coverage. For every 1 percent increase in the cost of insurance, 400,000 people lose their employer insurance or drop their own coverage. Third, those who retain their coverage must settle for lower benefits. When the government passed certain standards for mental health coverage, thousands lost what mental health benefits they had.

It would hardly be necessary for a consumer to bring legislative and regulatory issues to the attention of the insurance company. They have entire departments devoted to compliance with regulatory and legislative matters. Their insurance plans and contracts are further scrutinized by the state insurance departments for compliance, and the company cannot use a product until it has been approved by the regulating authorities. If there were a major piece of legislation mandating Viagra, it would be common knowledge by now.