Eligible groups for NHS funding for erectile dysfunction (ED)

The following groups of men are eligible for treatment with specified drugs (including Viagra) for erectile dysfunction under NHS guidance (1,2):

• diabetes
• multiple sclerosis
• Parkinson's disease
• poliomyelitis
• prostate cancer
• prostatectomy - includes TURP (2)
• radical pelvic surgery
• renal failure treated by dialysis or transplant
• severe pelvic injury
• single gene neurological disease
• spinal cord injury
• spina bifida

Also drug treatment can be prescribed to those men not included in the above categories but who were receiving drug treatment for impotence from their GP on 14th September 1998.

"For other men who are caused severe distress by impotence, it is proposed that treatment should be available in exceptional circumstances only after specialist assessment in a hospital (1)."

The drug treatments involved are (3,4):

• alprostadil (as generic and Caverjet, MUSE and Viridal brands)
• sildenafil (as Viagra brand only)
• tadalafil (as generic and Cialis brand)
• vardenafil (as generic and Levitra brand)
• avanafil (as generic and Spedra brand).

The use of non-drug treatments is not affected by NHS regulations.

Generic sildenafil is available for prescribing on the NHS for any patient with a diagnosis of erectile dysfunction (i.e. no longer is required to be prescribed on the NHS as 'SLS') (3,4). Also the generic drugs Apomorphine Hydrochloride, Moxisylyte Hydrochloride and Thymoxamine Hydrochloride are all removed from the 'SLS' list and can be prescribed in their generic form without annotating with the letters 'SLS' (3,4).

This guidance means that any patient with erectile dysfunction can be prescribed either generic sildenafil (or the generic drugs apomorphine hydrochloride, generic moxisylyte hydrochloride and thymoxamine hydrochloride) without need for adherence to the NHS eligibility criteria for prescription of medication for erectile dysfunction as previously defined (1,2) and listed above.

NHS treatment guidance indicates that one treatment a week will be appropriate for most patients with erectile dysfunction. However "if the GP in exercising his clinical judgement considers that more than one treatment a week is appropriate he should prescribe that amount on the NHS (2)."

Reference:

• (1) Department of Health Press Release (7/5/99). Impotence Consultation - Dobson announces final decision.
• (2) Health Service Circular (30/6/99). HSC 1999/148. Treatment for impotence.
• (3) Personal Communication (20/8/2014) - Mark Galloway (Head of Medicines Management, Department of Medicines Management, NHS Coventry & Rugby CCG)
• (4) Pharmaceutical Services Negotiating Committee (accessed 20/8/2014). Revisions to SLS list (Drug Tariff Part XVIIIB)