, Volume 19, Issue 5, pp 441–448 | Cite as

Lifestyle Drugs

Determining Their Value and Who Should Pay
Current Opinion


Lifestyle drugs are used to alleviate or enhance: (i) lifestyle problems or conditions, regardless of the cause; and (ii) health problems for which the underlying cause is in the realm of personal responsibility. It is the particular use of a drug, rather than its inherent properties, that determines whether it is called a lifestyle drug. The increasing availability of, and high demand for, lifestyle drugs contributes to their expanding role in healthcare.

In the absence of objective pharmacoeconomic data, the subjective value or cost effectiveness of these agents varies among patients, medical professionals, regulatory agencies and payors. Most nations rely on value systems that are implied, rather than clearly articulated.

The aims of largely institutional payors, and the individual patients and their physicians do not always coincide, creating tensions over who should pay for these drugs. Cost-sharing between patient and payer, drug limitations and prior authorisation protocols are some methods used to manage access to these drugs.

There is an urgent need to formulate coherent values, priorities and strategies for dealing with lifestyle drugs. To do this, local and national regulatory agencies, politicians, healthcare providers, insurers and patients need to formulate broad areas of consensus. Finally, we must not forget compassion for the patient as we apply the dictates of institutional policy.


  1. 1.
    Gilbert D. Lifestyle drugs: who will pay? Scrip Reports Industry Alert. Richmond, Surrey: PJB Publications Ltd, 1999Google Scholar
  2. 2.
    Leape LL, Park RE, Solomon DH, et al. Does inappropriate use explain small-area violations in the use of health care services? JAMA 1990 Feb 2; 263 (5): 669–72PubMedCrossRefGoogle Scholar
  3. 3.
    Kahn KL, Kosecoff J, Chassin MR, et al. Measuring the clinical appropriateness of the use of a procedure: can we do it? Med Care 1988 Apr; 26 (4): 415–22PubMedCrossRefGoogle Scholar
  4. 4.
    Kosecoff J, Fink A, Chassin MR, et al. The appropriateness of medical services. HealthSpan 1987 Jun; 4 (6): 18–21PubMedGoogle Scholar
  5. 5.
    Brook RH, Chassin MR, Fink A, et al. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 1986; 2 (1): 53–63PubMedCrossRefGoogle Scholar
  6. 6.
    Glasziou PP, Schwartz S. Clinical decision analysis. Med J Aust 1991 Jan 21; 154: 105–10PubMedGoogle Scholar
  7. 7.
    Greene J. Al wants more hair, less fat, and a better sex life... and he wants his health plan to pay for it. Hosp Health Netw 1999 Mar 1; 73 (3): 36PubMedGoogle Scholar
  8. 8.
    Mahkorn S. Why an unreformed Medicare system is hazardous to your health. Backgrounder No. 1295. Washington, DC: The Heritage Foundation, 1999 June 18. Available from: URL: [Accessed 2000 Nov 22]Google Scholar
  9. 9.
    Parens E. Is better always good? The enhancement project. Special supplement to the Hastings Centre Report. Garrison (NY): The Hastings Centre, 1998 Jan/FebGoogle Scholar
  10. 10.
    Leifer J. Say a prayer for health care’s future. Hosp Health Netw 1998 Jul 5; 72 (13): 82PubMedGoogle Scholar
  11. 11.
    Fitzpatrick M. Debating drugs. LM Comment 1998 Nov 23 [online]. Available from: URL: [Accessed 2000 Jun 8]Google Scholar
  12. 12.
    PCS Health Systems, Inc. Uprima™ on the market soon. PCS Advisor Update 2000 June 23; 2 (4) [online]. Available from: URL: [Accessed 2000 Mar 16]Google Scholar
  13. 13.
    Sevon M, Mitrany D. Quality-of-life drugs: framing the issue. J Manage Care Pharmacy 1999 May/Jun; 5 (3): 185, 189–90Google Scholar
  14. 14.
    Herman R. The ‘lifestyle’ phenomenon: pills to enhance well-being. International Herald Tribune 1998 Nov 18: 21 [online]. Available from: URL: [Accessed 2000 Jun 8]Google Scholar
  15. 15.
    Hensley S. Prescription costs become harder to swallow: providers and payers get a big dose of reality with explosive spending and patient demand for new drugs. Mod Healthcare 1999 Aug 23: 30Google Scholar
  16. 16.
    Gebhart F. Patient demand for lifestyle drugs putting R.Ph.s in a bind. Drug Topics 1999 Aug 2; 143 (15): 61Google Scholar
  17. 17.
    Casey M. Viagra: Pandora’s box for insurers? Med Ind Today 1998 Jul 14 [online journal available from: URL:]Google Scholar
  18. 18.
    Garner T. Lifestyle drugs used to treat quirks not illnesses. Weekend Herald 1998 Sept 5–6 [online].Available from:URL: [Accessed 2000 Jun 8]Google Scholar
  19. 19.
    Baldauf S. Rise of ‘lifestyle’ drugs straining health costs. Christian Science Monitor 1999 Sep 13 [online]. Available from: URL: [Accessed 2000 Jun 8]Google Scholar
  20. 20.
    Capella P, Boseley S. UN agency on the offensive against the abuse of ‘lifestyle’ drugs. The Observer 1999 Feb 24 [online]. Available from: URL:,2867,25799,00.html [Accessed 2000 Jul 5]Google Scholar
  21. 21.
    Darling H. Sex and happiness are not the goals of health coverage: should employers pay for viagra? Bus Health 1998 Jun; 16 (6): 55Google Scholar
  22. 22.
    Weber J, Barrett A, Mandel M, et al. The new era of lifestyle drugs. Business Week 1998 May 11 [online]. Available from: URL: [Accessed 2000 Jun 8]Google Scholar
  23. 23.
    Neil R. HMOs develop allergic reaction to drug ads. Med Ind Today 1999 May 12 [online journal available from: URL:]Google Scholar
  24. 24.
    Plumb JM, Guest JF. Annual cost of erectile dysfunction to UK society. Pharmacoeconomics 1999; 16 (6): 699–709PubMedCrossRefGoogle Scholar
  25. 25.
    Tan HL. Economic cost of male erectile dysfunction using a decision analytic model: for a hypothetical managed-care plan of 100 000 members. Pharmacoeconomics 2000; 17 (1): 77–107PubMedCrossRefGoogle Scholar
  26. 26.
    Cerulli J, Malone M. Outcomes of pharmacological and surgical treatment for obesity. Pharmacoeconomics 1998; 14 (3): 269–83PubMedCrossRefGoogle Scholar
  27. 27.
    Titlow K, Randel L, Clancy CM, et al. Drug coverage decisions: the role of dollars and values. Health Aff (Millwood) 2000; 19 (2): 240–7CrossRefGoogle Scholar
  28. 28.
    Rotella DP, Sun Z, Zhu Y, et al. N-3-substituted imidazoquinazolinones: potent and selective PDE5 inhibitors as potential agents for treatment of erectile dysfunction. J Med Chem 2000; 43 (7): 1257–63PubMedCrossRefGoogle Scholar
  29. 29.
    Burton SL. An ethicist’s evaluation of drug coverage. Drug Benefit Trends 2000; 12 (2): 58–9Google Scholar
  30. 30.
    Segedin DA. Three-tier co-payment plans: design considerations and effectiveness. Drug Benefit Trends 1999 Sep; 11 (9): 43–44, 44–48, 51–52Google Scholar
  31. 31.
    Kleinke JD. Just what the HMO ordered: the paradox of increasing drug costs. Health Aff 2000 Mar/Apr: 19 (2): 78–91CrossRefGoogle Scholar
  32. 32.
    Staff reports. Aetna US Healthcare excludes viagra from coverage. Med Ind Today 1998 Jun 17 [online journal available from: URL:]Google Scholar
  33. 33.
    Keith A. The economics of viagra: a new blockbuster drug raises important questions about what is viewed as ‘medical necessity’ by insurers. Health Aff 2000 Mar/Apr; 19 (2): 147–57CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Advance-PCSScottsdaleUSA

Personalised recommendations