Implantable penile prostheses (IPPs) are an established treatment option for erectile dysfunction (ED), and are covered by insurance in about 80% of cases, reports a paper in the September issue of Urology Practice.
A recent study reported that while the use of medications to treat ED has remained stable over the past decade, use of IPPs and other treatments has declined. It is unclear whether lack ofDr. Khera and colleagues used health plan benefit verification databases to assess approval status for prescribed IPP treatment for the years 2018 to 2021.
Overall, about 80% of patients had insurance coverage for IPP. Government insurance plans offered the most extensive coverage: 98.7% for Medicare, 97.1% for Medicare Advantage, 100% for Tricare , and 80% for Veterans Affairs. Coverage for commercial insurance was also favorable at 75%., falling under 50% for some categories. For patients with employer-sponsored health plans, the most common reason for denial was that the plan specifically excluded coverage for IPPs.
Employer exclusions of IPP coverage create"confusion and frustration" for clinicians, the researchers write. Such exclusions"usurp the clinicians' determination of medical necessity under the health plan's medical policy, make it difficult for providers to implement ED treatment guidelines appropriately, and limit essential treatment for patients with ED."
The findings suggest that employer exclusions may have contributed to the reported decreases in IPP use in recent years. Dr. Khera and colleagues conclude,"Per AUA guideline recommendations, it is imperative to ensure that all types of effective ED treatments are consistently accessible to patients."
Dr. Khera adds,"The employer exclusion could also have a negative impact on the quality of life of patients recovering fromMohit Khera et al, Implantable Penile Prosthesis for Erectile Dysfunction: Insurance Coverage in the United States,
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Insurance coverage for implantable penile prostheses varies by type of insuranceImplantable penile prostheses (IPPs) are an established treatment option for erectile dysfunction (ED), and are covered by insurance in about 80% of cases, reports a paper in the September issue of Urology Practice®, an Official Journal of the American Urological Association (AUA).
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