“Medicare†“penis pumps,†and “taxpayers†aren’t often grouped together as a concept, but a recent report by the US Office of the Inspector General (OIG) has indirectly highlighted the reality of sex among senior citizens due to inflated prices paid by Medicare for pumps designed to address erectile dysfunction (ED)

Medicare offers limited help to older men with erectile dysfunction.

Medicare has been paying for vacuum erection systems (VESs) that help men achieve erections so they can enjoy sex. Sometimes called a vacuum constriction device (VCD), the VES is a pump worn externally that draws blood into the penis, producing an erection. The device consists of an acrylic cylinder with a pump. The cylinder is placed over the penis, with a constricting ring or band applied to create a seal. The pump is then used to create a vacuum, which draws blood into the penis. The band helps maintain the erection.

What Medicare Covers in Terms of ED Treatment

Medicare, the health insurance program that covers individuals over age 65, pays most of the cost of a VES for men on Medicare who have ED. The devices are rather clunky and inconvenient, but they work fairly well, and many older men rely on them. In contrast, Medicare does not cover pharmaceutical treatments for ED, including drugs in the PDE-5 inhibitor class, which includes Viagra, Levitra, Staxyn, and Cialis. If a man on Medicare wants to take one of these drugs, he has to pay for it out of pocket.

Why the Recent Uproar Over Medicare’s VES Payments?

The OIG report found that from 2006 to 2011, Medicare paid an average of $451 per VES device. Medicare recipients pay $90 of this through a co-pay, with Medicare covering the balance. The reason the OIG report was controversial was that the Department of Veterans Affairs paid only $186 per pump. Plus, if you search around online, you can buy the devices for even less. For example, they can be found for around $125 on Amazon, where they’re eligible for free shipping under Amazon Prime. Complaints about the findings of the OIG basically fall into two categories: 1) Why does Medicare pay over three times what these devices typically sell for? And 2) Why is Medicare helping older people have sex?

Older People Are More Sexually Active Than You Might Think

The fact is, older people are more sexually active than many people think. The Department of Health and Human Services released a report on Medicare last year stating that in 2011 and 2012, 2.2 million Medicare recipients were screened for sexually transmitted diseases, and more than 66,000 were tested for HIV. And these are just the ones who paid for the testing through Medicare. Others may have paid out of pocket for these tests. Furthermore, from 2007 to 2011, the prevalence of sexually transmitted chlamydia among Americans age 65 and older increased by 31%, while syphilis increased by 52%. These numbers are surprisingly close to the increases reported in the 20- to 24-year-old age group.

Fulfilling sexual relationships don’t necessarily stop because of age.

Alternatives for Older Men Facing ED

Since ED rates increase with age, men who are eligible for Medicare often must cope with ED too. While many older men can safely take drugs like Viagra, others cannot due to heart conditions. Medicare-eligible men who don’t want to pay for ED drugs out of pocket are limited in their options for treating ED. They can, of course, make certain lifestyle changes like quitting smoking, losing excess weight, and getting high blood glucose levels under control. But if they want a medical treatment for ED that’s paid for by Medicare, VES devices are basically their only choice.

Recommendations of the Office of the Inspector General

What can Medicare do about the high prices it pays for VES devices? The Centers for Medicare & Medicaid Services (CMS) allows competitive bidding for some types of durable medical equipment, and this results in price drops of around 45% in many cases. VES devices are not part of the competitive bidding program, but the OIG says that if they were subject to competitive bidding, Medicare could save millions of dollars per year. The OIG recommends that if VES prices are “grossly excessive†Medicare should establish a payment limit or seek legislative authority to include VES devices in the competitive bidding program.

Older men who are medically eligible to take drugs like Viagra shouldn’t expect any help in paying for them from Medicare any time soon. They can, however, obtain a prescription and pay for these drugs out of pocket. AccessRx.com sells genuine brand name Viagra, Levitra, Staxyn, and Cialis at competitive prices. AccessRx.com uses speedy, reliable shipping with trusted couriers like FedEx, and is dedicated to the highest standards of customer service, personal privacy, and online ordering security.

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