The ABLE Act, working its way through Congress, contains a provision cutting Medicare coverage for penis pumps.Tucked away among the many provisions of the overwhelmingly popular Achieving a Better Life Experience Act — the ABLE Act — is one that aims to end Medicare coverage for the only form of impotence treatment still available under the nation’s broad-ranging program for elder health care.
The ABLE Act itself paves the way for the creation of tax-free savings accounts in which individuals with disabilities — and their families — could set aside funds that would be used for future care.
Ends Penis Pump Coverage
As for the provision on impotence treatments, if approved it would cut off Medicare coverage for vacuum erection systems, more popularly known as penis pumps and the only type of ED treatment still covered under Medicare.
Under the terms of the provision, coverage for penis pumps would continue to be banned ¨until such time that Medicare covers erectile dysfunction drugs under Medicare Part D.¨
In a sense, passage of the Medicare provision would create an even playing field for all men suffering from erection problems in that no form of treatment for impotence would be covered presumably until all forms of treatment are covered.
No Coverage for Impotence Drugs
The Centers for Medicare and Medicaid Services, which oversees coverage for both healthcare programs, explicitly excludes coverage for ¨drugs when used for treatment of sexual or erectile dysfunction, unless such agents are used to treat a condition, other than sexual or erectile dysfunction, for which the agents have been approved by the FDA.¨
Taking their cue from the federal government’s policy on coverage for treatment of erection problems, many private insurers exclude most forms of impotence treatment from the coverages they provide for their policyholders.
Self-Inflicted Health Damage?
At their heart, these policies seem to view erection problems as self-inflicted health damage that neither the government nor private insurers should feel any obligation to cover. But, then, taken to its logical conclusion, this line of thinking might very well be extended to exclude health care coverage for heart attacks, strokes, diabetes, and other health problems that could be traced to patients’ unhealthy lifestyle choices. Fortunately, neither the government nor the insurance industry has thus far shown any inclination to move in that direction.
Medicare’s Part D provides no coverage for impotence medications unless such drugs are used to treat a condition other than impotence.If the ABLE Act passes with the provision ending Medicare coverage for penis pumps intact, men who are covered by Medicare or Medicaid will have to pay for all forms of impotence treatment out of their own pocket. Alternatively, they might try to find private health insurance coverage that provides at least some degree of reimbursement for some impotence treatments. Such plans undoubtedly will carry higher premiums and may very well require heavy copayments for any forms of impotence treatment that they do cover.
The essential injustice of covering one type of impotence treatment but not others doesn’t appear to have been the primary motivating factor for legislative action to cut off coverage for penis pumps.
Wasteful Spending Alleged
Instead, it seems the impetus for the legislation came from a December 2013 report from the inspector general at the Department of Health and Human Services that found Medicare was paying roughly double the market price for penis pumps. According to ABCNews.go.com, the pumps are typically available to consumers for about $150.
According to the inspector general’s report, ¨Medicare payment amounts for VES [vacuum erection systems] remain grossly excessive compared with the amounts that non-Medicare payers pay. Medicare currently pays suppliers more than twice as much for VES as the Department of Veterans Affairs and consumers over the Internet pay for these types of devices.”
Will Help Fund ABLE Act
The reason for including this seemingly unrelated provision in the ABLE Act turns out to be pretty straightforward. Legislators are hoping that the savings realized from ending Medicare’s penis pump coverage will offset in part the costs associated with creating tax-free savings accounts for disabled Americans.
It is estimated that Medicare paid $172 million for 474,000 penis pumps between 2006 and 2011. The Congressional Budget Office predicts that federal government coffers will realize an annual savings of about $45 million from eliminating penis pump coverage, or $444 million over the next decade.
Whether Congress will ever extend Medicare Part D coverage to include popular impotence drugs is anyone’s guess. However, the chances for any such development in the short term are slim to none because of the huge added cost such a move would entail.
If pending legislation passes, couples facing the challenge of erection problems, will have to fund treatment out of their own pockets.Patents Will Expire Soon
Somewhere down the line, when the original patents for most of the PDE5 inhibitors, such as Viagra, Levitra, and Cialis, have expired and most of these drugs are made available in generic form, perhaps legislators will take a more enlightened view about the importance of treating erection problems.
In the meantime, these drugs remain the most popular form of treatment for impotence and are probably likely to grow in popularity as their costs gradually come down. Under the terms of an agreement that Pfizer, creator of Viagra, struck with Teva Pharmaceuticals, the latter will be allowed to release a generic formulation of sildenafil citrate, the active ingredient in Viagra, beginning in December 2017. For this privilege, Teva will pay Pfizer a royalty until the drugmaker’s U.S. Viagra patent expires in April 2020.
In addition to the arrival of a generic form of Viagra in late 2017, the U.S. patents for Cialis and Levitra are now scheduled to expire in 2017 and 2018, respectively. This will open the door to additional generic competition, which will bring prices for impotence drugs within the reach of additional consumers.
Reliable Online Source
In the meantime, if you’re looking for a reliable online source for these drugs, eDrugstore.com is an excellent candidate. Part of the Secure Medical family of online drugstores, eDrugstore sells only FDA-approved medications that are sourced from licensed U.S. pharmacies.
All medications ordered through eDrugstore are shipped in flat FedEx or U.S. Postal Service envelopes from a U.S. pharmacy. However, to protect your privacy and prevent theft, labels on these packages do not identify a pharmacy, apothecary, or drugstore as the shipper.
If you already have a prescription from your doctor for an impotence drug, you can fax or scan and email it to eDrugstore along with your order. If you don’t have a prescription or are reluctant to discuss your erection problems with a medical professional, eDrugstore can arrange an online consultation with one of its contract physicians.
To facilitate such a consultation, you’ll be required to fill out a medical questionnaire that covers your medical history as well as your current complaint. One of eDrugstore’s licensed physicians will review your questionnaire and authorize a prescription if he or she feels it is warranted.
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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