Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide

International Journal of Impotence Research volume 33, pages 55–58 (2021)Cite this article

Subjects

Abstract

A lack of uniformity exists for insurance payer coverage for all categories of penile prostheses (PP). We sought to determine common insurance coverage criteria and barriers to implantation across common insurance plans from healthcare referral regions (HRR) nationwide. Coverage criteria and stipulations were reviewed regarding erectile dysfunction (ED) etiology, ED duration, contributing comorbid conditions, medications, drug use, diagnostic tests, use of procedures and prior interventions. Seventy of 100 plans included coverage criteria. 36.1% provided coverage only in cases of gender dysphoria. 27.7% required documentation of trial, contraindication or intolerance to pharmacologic therapy, with varying descriptors of what this entailed. 13.8% required at least consideration of prior pharmacologic therapy. 4.2% required trial or contraindication to classic second-line therapies. 25.0% stated that ED must be organic. Psychogenic ED was covered by 12.5% of plans. Eleven plans required at least 6 or 12 months of symptoms. Laboratory evaluation to rule out hypogonadism or hyperprolactinemia was required by five plans. Insurance coverage criteria for PP placement were highly variable by state and plan. Coverage is provided for PP implantation in most cases for ED of organic etiology following failure of pharmacologic therapy when contributing comorbidities are optimally managed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Lewis RW, Fugl‐Meyer KS, Corona G, Hayes RD, Laumann EO Jr., et al. Original articles: definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7:1598–607. ED

    Article  Google Scholar 

  2. Klaassen Z, Arora K, Wilson SN, King SA, Madi R, Neal DE, et al. Decreasing suicide risk among patients with prostate cancer: implications for depression, erectile dysfunction, and suicidal ideation screening. Urol Oncol Semin Orig Investig. 2018;36:60–66.

    Google Scholar 

  3. Shabsigh R, Klein LT, Seidman S, Kaplan SA, Lehrhoff BJ, Ritter JS. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology. 1998;52:848–52.

    Article  CAS  Google Scholar 

  4. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction. Psychosom Med. 1998;60:458–65.

    Article  CAS  Google Scholar 

  5. Nelson CJ, Mulhall JP, Roth AJ. The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. J Sex Med. 2011;8:560–6.

    Article  Google Scholar 

  6. Carson CC, Mulcahy JJ, Govier FE, Group A. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. J Urol. 2000;164:376–80.

    Article  CAS  Google Scholar 

  7. Carson CC, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: Up to 7.7 years of followup. J Urol. 2011;185:614–8.

    Article  Google Scholar 

  8. Lewis R. Long-term results of penile prosthetic implants. Urol Clin N Am. 1995;22:847–56.

    CAS  Google Scholar 

  9. Daitch JA, Angermeier KW, Lakin MM, Ingleright BJ, Montague DK. Long-term mechanical reliability of AMS 700 series inflatable penile prostheses: comparison of CX/CXM and ultrex cylinders. J Urol. 1997;158:1400–2.

    Article  CAS  Google Scholar 

  10. Çayan S, Aşcı R, Efesoy O, Bolat M, Akbay E, Yaman Ö. Comparison of long-term results and couples’ satisfaction with penile implant types and brands: lessons learned from 883 patients with erectile dysfunction who underwent penile prosthesis implantation. J Sex Med. 2019;16:1092–9.

    Article  Google Scholar 

  11. Althof SE, Buvat J, Gutkin SW, Belger M, Stothard DR, Fugl‐Meyer AR. Sexual satisfaction in men with erectile dysfunction: correlates and potential predictors. J Sex Med. 2010;7:203–15.

    Article  Google Scholar 

  12. Masterson JM, Kava B, Ramasamy R. Commercial insurance coverage for inflatable penile prosthesis at a tertiary care center. Urol Pract. 2018;6:155–8.

    Article  Google Scholar 

  13. Le B, McAchran S, Paolone D, Gralnek D, Williams D, Bushman W. Assessing the variability in insurance coverage transparency for male sexual health conditions in the United States. Urology. 2017;102:126–9.

    Article  Google Scholar 

  14. Segal R, Camper S, Burnett A. Modern utilization of penile prosthesis surgery: a national claim registry analysis. Int J Impot Res. 2014;26:167.

    Article  CAS  Google Scholar 

  15. Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200:633–41.

    Article  Google Scholar 

  16. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57:804–14.

    Article  Google Scholar 

  17. SE1511 CM. Discontinued coverage of vacuum erection systems (VES) prosthetic devices in accordance with the achieving a better life experience act of 2014. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1511.pdf. Accessed 27 Oct 2019.

  18. Akerman J, Kovac JR. An increased prevalence of medical co-morbidities may underscore future growth in the numbers of men requiring penile prostheses. Transl Androl Urol. 2017;6:S858–9.

  19. Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84:50–6.

    Article  CAS  Google Scholar 

  20. Wilson SK, Delk JR. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol. 1995;153:659–61.

    Article  CAS  Google Scholar 

  21. Lipsky MJ, Onyeji I, Golan R, Munarriz R, Kashanian JA, Stember DS, et al. Diabetes is a risk factor for inflatable penile prosthesis infection: analysis of a large statewide database. Sex Med. 2019;7:35–40.

    Article  Google Scholar 

  22. Gross MS, Reinstatler L, Henry GD, Honig SC, Stahl PJ, Burnett AL, et al. Multicenter investigation of fungal infections of inflatable penile prostheses. J Sex Med. 2019;16:1100–5.

    Article  Google Scholar 

  23. Balen A, Gross MS, Phillips EA, Henry GD, Munarriz R. Active polysubstance abuse concurrent with surgery as a possible newly identified infection risk factor in inflatable penile prosthesis placement based on a retrospective analysis of health and socioeconomic factors. J Sex Med. 2016;13:697–701.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Kevin Krughoff & Martin S. Gross

  2. Boston University Medical Center, Boston, MA, USA

    Ricardo M. Munarriz

Authors
  1. Kevin Krughoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricardo M. Munarriz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin S. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin S. Gross.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krughoff, K., Munarriz, R.M. & Gross, M.S. An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide. Int J Impot Res 33, 55–58 (2021). https://doi.org/10.1038/s41443-019-0226-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-019-0226-8

This article is cited by

Search

Advanced search

Quick links