House looks to pump the brakes on Medicare coverage of erectile disfunction aids

Posted at 1:30 PM, Dec 03, 2014
and last updated 2014-12-03 14:59:18-05

Medicare has paid more than $250 million in the past decade for vacuum erection systems -  yes that’s right, penis pumps - to treat erectile dysfunction in elderly or disabled patients.

But Congress is considering legislation that would trade off Medicare coverage of the pumps to help pay for a new tax-favored savings plan that would help disabled people live independently.

The Congressional Budget Office says the Achieving a Better Life Experience, or ABLE Act – which the House is expected to approve Wednesday --  would add $2.1 billion to the federal deficit over 10 years, so the act's sponsors have to come up ways to offset the cost. The Senate has yet to act on the bill.

The savings accounts would work much like those widely used by parents, grandparents and others to help pay for college tuition, but would instead pay for health, training, housing, transportation and other services needed by a disabled beneficiary.

Dropping coverage for penis pumps would save an estimated $444 million in the next decade, according to the CBO. The devices have been a target of fiscal conservatives for years amid reports of fraud and excessive payments.

The bill prohibits coverage of vacuum erection systems “until such time that Medicare covers erectile dysfunction drugs.”

Medicare typically pays 80 percent of the cost of the devices when prescribed by a physician, and about half of American men in their 60s and beyond experience erectile dysfunction. Vascular disease or diabetes are the most typical underlying causes.

Spending for the pumps has soared in recent years largely because of Medicare rules to end coverage of drugs for erectile dysfunction starting in 2007. That meant men on Medicare could only get help paying for vacuum pumps, or if those don’t work, coverage for penile implants.

Only a few companies make the pumps for sale as medical devices – as opposed to sex novelties – and insist numerous scientific studies show the pumps are effective.

But their cause has been hurt by some scams like an Illinois company that bought pumps from an online sex shop for about $26 each and billed Medicare $284 each after shipping them to diabetic patients who hadn’t even requested them.

Last year, the Inspector General for the Department of Health and Human Services issued a report that concluded Medicare paid “grossly excessive” prices for the pumps compared to prices paid by non-Medicare recipients.

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