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Comment on “An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide” by Dr. Gross et al.

International Journal of Impotence Research volume 33, pages 122–123 (2021)Cite this article

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The Original Article was published on 02 January 2020

The authors highlight the disconnect between health insurance industry standards and urologic society guidelines for the treatment of erectile dysfunction (ED). They meaningfully contribute to the literature by performing a deep-dive into specific exclusion criteria put forth by major insurance providers [1]. The current coverage criteria for penile prosthesis put forth by many commercial insurers is simply outdated and based on old guidelines. In the most recent guidelines put forth by the American Urological Association, penile prosthesis is now considered an acceptable treatment for ED as part of the shared-decision making approach and should be readily available along with other options. Men should no longer be forced to fail “conservative” therapy by way of oral and injectable medication prior to penile prosthesis [2].

Medicare has set an encouraging standard with providing coverage for penile prosthesis, however the lack of similar coverage by commercial insurance providers leaves a large population (~50%) of men with erectile dysfunction uncovered [3]. The authors mention that the majority of commercially-insured penile prostheses are implanted before the age of 65 [1]. Considering that only half of commercial insurers provide coverage for penile prosthesis, it is reasonable to conclude that for every man under the age of 65 receiving coverage for penile prosthesis there is another man with ED who has failed medical therapy and is left wanting.

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References

  1. Krughoff K, Munarriz RM, Gross MS. An asessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide. Int J Impot Res. 2020.

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

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  3. Masterson JM, Kava B, Ramasamy R. Commercial insurance coverage for inflatable penile prosthesis at a tertiary care center. Urol Pract. 2019;6:155–8.

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Authors and Affiliations

  1. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    John M. Masterson

  2. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA

    Thomas A. Masterson III & Ranjith Ramasamy

Authors
  1. John M. Masterson
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  2. Thomas A. Masterson III
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  3. Ranjith Ramasamy
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Correspondence to John M. Masterson.

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Masterson, J.M., Masterson, T.A. & Ramasamy, R. Comment on “An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide” by Dr. Gross et al.. Int J Impot Res 33, 122–123 (2021). https://doi.org/10.1038/s41443-020-0278-9

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  • DOI: https://doi.org/10.1038/s41443-020-0278-9

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