A class action challengingthe policy of Oxford Health Plans and Oxford Health Insurance regardingcoverage for the erectile dysfunction treatment Viagra has been clearedto proceed in a searing decision by a federal judge in Brooklyn.Eastern District Judge RaymondJ. Dearie rejected Oxford’s contention that the suit, Sibley-Schreiberv. Oxford Health Plans, 98 CV 3671, should be dismissed for plaintiffs’failure to exhaust the administrative claims process provided by the insuranceplans.
The judge called Oxford’scontention offensive to “notions of fairness and common sense,” given thefact that the exhaustion requirement is hidden “behind an arguabl[e] thicketof misleading legalese” in the Oxford membership handbook.Each of the four plaintiffsclaims to suffer from “organic impotence” and to have been prescribed Viagraby a physician shortly after the drug received FDA approval in March 1998.Oxford announced in June 1998 that it would pay for only six Viagra pillsper month, regardless of the number of pills prescribed by a physician.
