Viagra special report

BMJ 1998; 317 doi: (Published 26 September 1998) Cite this as: BMJ 1998;317:836

Viagra falls: the debate over rationing continues

Britain is not the only country to decide that the cost of sildenafil citrate (Viagra) may be too great for its health service to bear. The granting of a European licence last week has triggered a debate about rationing throughout the European Union. Some countries, such as Germany, have already decided that patients with erectile dysfunction must pay for the drug themselves whereas others are still weighing up the pros and cons. In the United States, Israel, and Switzerland, where the drug has been licensed for a few months, demand has started to decline but the debate continues.


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Linda Beecham, BMJ

The BMA is urging the health departments to make a decision about the availability or otherwise of sildenafil under the NHS as quickly as possible.

The Standing Medical Advisory Committee has advised that doctors should not prescribe the drug to patients needing treatment for erectile dysfunction other than “in exceptional circumstances” (19 September, p 765). The General Practitioners Committee (GPC) is advising doctors to follow this advice, although, as the drug has not been added to the list of drugs not available under the NHS, it would not be illegal to prescribe the drug. GPs who believe that they have a patient whose clinical case is exceptional are advised to discuss the matter with the health authority's medical adviser before prescribing.

GPs may not issue a private prescription for the drug to one of their own NHS patients or to any patient registered with one of their partners. They may issue a private prescription to a private patient who is not on their or their partners' NHS list and charge a fee for the consultation and for issuing a prescription. The BMA currently suggests £114.50 ($180) an hour pro rata for a private consultation and £7.50 …

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