Sexual Health


Oct 08, 2018

It’s no secret that our bodies change as we age. We might not move as quickly, hear as clearly, or see as vividly as we did when we were younger. But while some changes might seem inevitable, getting older doesn’t mean we’re down for the count.

Sexual function is no different. As men get older, they might start having trouble with erections. It can take longer to get aroused or become more difficult to get a fully firm erection. Older men may also be more prone to health conditions that contribute to poor erections, like low testosterone, diabetes, and heart disease. Treatment for certain types of cancer, like prostate cancer, can affect erections, too.

The good news is that men with erectile dysfunction (ED) have many treatment options available. Pills, self-injections, vacuum erection devices, urethral suppositories, and penile implant surgery are all possibilities.

Unfortunately for older men in the United States, Medicare usually does not cover ED treatments, as they are not considered medically necessary.

Today, we’ll discuss some of the basics of Medicare coverage for ED. Please note that this is a brief summary. Medicare has many components, and we encourage you to see the Medicare website for complete details.

What is Medicare?

Medicare is a health insurance program for people age 65 and older in the United States. People under age 65 may qualify if they have certain disabilities. Patients with end-stage renal disease may be eligible at any age.

Generally, Medicare comes in three main categories:

  • Medicare Part A – This part helps cover people when they are in the hospital.
  • Medicare Part B – This part helps cover doctor’s visits and outpatient services.
  • Medicate Part D – This part covers some, but not all, prescription drugs.

ED and Medicare: A General Overview

Medicare’s ED coverage as of October 2018 is as follows:

Treatment

Examples

Covered?

Medication – Phosphodiesterase type 5 (PDE5) inhibitor pills

Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil)

If prescribed for ED: No

 

If prescribed for another condition: Maybe

Medication – self-injections

Caverject, Edex (papaverine, phentolamine and/or alprostadil)

No

Medication – urethral suppositories

MUSE (alprostadil)

No

Vacuum erection devices

 

No

Penile implant (prosthesis)

 

Under certain circumstances.  See below.  

Note: In general, Medicare covers penile implants when certain criteria are met. Medicare covers penile implants if erectile dysfunction is caused by an underlying medical condition, such as diabetes, coronary artery disease, or Peyronie's disease. It is also covered after radical prostatectomy, a surgical treatment for prostate cancer.

In addition, the patient must try other ED therapies, such as testosterone replacement therapy, injections, or PDE5 inhibitors first. If these approaches do not work, then implants may be covered.

Medications needed in connection with surgery might be covered under Medicare Plan D. 

Replacement of the implant may be covered if it breaks or becomes infected as long as the implant is still medically necessary and is not under warranty.

Patients should always confirm their coverage with their insurance provider before having penile implant procedures.

What can men do?

ED treatments can be expensive, and lack of coverage can be disappointing. But there might still be ways to receive treatment. Here are some steps to consider:

  • Talk to your doctor. ED is linked to a variety of chronic illnesses, such as diabetes and heart disease. Sometimes, treatment for those conditions, or even just changing your lifestyle, alleviates erection problems to some degree. Make sure you are doing everything you can to stay healthy. If you have diabetes, check your blood sugar regularly and follow your doctor’s diet recommendations exactly. If you are overweight, ask your doctor about weight-loss plans and exercise. If you smoke, inquire about smoking cessation programs. Medicare may cover conditions that lead to ED, even if it doesn’t cover ED treatments directly.
  • Talk to your health insurer. Find out if there are any other coverage avenues to try.
  • Look for coupons, discounts, and sales. Some drug manufacturers offer coupons and discounts for their products. For example, as of October 2018, Pfizer, the manufacturer of Viagra, is offering a 50% discount on up to 12 Viagra prescriptions per year. Pfizer also offers an assistance program. Other manufacturers might offer similar deals. Your pharmacist may know of other discount programs. Be sure to ask.
  • Consider contacting your State Pharmaceutical Assistance Program. Some states have programs that help their residents pay for their medications. Eligibility can vary from state to state. See more informationhere.

Remember…

While Medicare is fairly standard, people’s individual situations are different. What is covered for your neighbor might not necessarily be covered for you - and vice versa - so it’s always important to double check your benefits with Medicare and any other insurance organization.

Medicare planning can be quite complex, and rules can change. If you need help, don’t hesitate to contact Medicare directly. (You’ll also find information translated into over 20 languages.) You might also contact organizations for seniors, such as the National Council on Aging or the AARP. Your local senior center might offer help as well.

For more information about erectile dysfunction, please click here.

Resources

Blue Cross Blue Shield of North Carolina

“Medicare Part C Medical Coverage Policy Penile Implants”

(Reviewed: July 12, 2017)

https://www.bluecrossnc.com/sites/default/files/document/attachment/services/public/pdfs/bluemedicare/medicalpolicy/penile_implants.pdf

Centers for Medicare and Medicaid Services

“Items and Services Not Covered Under Medicare”

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-and-Services-Not-Covered-Under-Medicare-Booklet-ICN906765.pdf

“Medicare Program - General Information”

(Page last modified: June 1, 2018)

https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html

GoodRx.com

“Muse Medicare Coverage”

https://www.goodrx.com/muse/medicare-coverage

Medicare.com 

(Note: Medicare.com is not the U.S. Government website for Medicare.  That website is www.Medicare.gov.)

Cross, Jory

“Does Medicare cover penile implants?”

(Updated: September 10, 2018)

https://medicare.com/coverage/does-medicare-cover-penile-implants/

Olmos, Mike

“What ‘Medically Necessary’ Means and How It Affects Your Medicare Coverage”

(Updated: September 16, 2018)

https://medicare.com/resources/what-medically-necessary-means-and-how-it-affects-your-medicare-coverage/

Medicare Interactive

“Drugs excluded from Part D coverage”

(https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-coverage/drugs-excluded-from-part-d-coverage

National Council on Aging

“Medicare Part D Drug Plans: What They Must, May, and Cannot Cover”

(PDF. August 2017)

https://www.ncoa.org/wp-content/uploads/part-d-drug-coverage-rules.pdf

Pfizer

“Find Assistance That's Right for You”

https://www.pfizerrxpathways.com/

“Save 50% on brand-name VIAGRA for up to 12 prescriptions per year”

https://www.viagra.com/savings-offer

SexHealthMatters

“Self-Injection - Erectile Dysfunction”

https://www.sexhealthmatters.org/erectile-dysfunction/self-injection-erectile-dysfunction

WebMD

“Erectile Dysfunction: Penile Prosthesis”

(September 11, 2017)

https://www.webmd.com/erectile-dysfunction/guide/penile-prosthesis#1



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Sep 05, 2018

Sildenafil. Tadalafil. Vardenafil. Avanafil. These may sound like complex drug names, but you probably know them by their brands names: Viagra, Cialis, Levitra, and Stendra. They are all in a class of drugs called phosphodiesterase type 5 (PDE5 inhibitors), and for many years now, they have helped thousands of men with erectile dysfunction (ED) get their sex lives back.

But like any drugs, PDE inhibitors have their side effects and risks. In 2014, we reported on a possible link between one of the drugs – sildenafil – and melanoma, the deadliest form of skin cancer. At that time, more research was needed, and men were advised not to change any of their medications without talking to their doctor.

The following year, scientists concluded that ED drugs probably didn’t cause melanoma, although they still found a link. Lifestyle factors could play a role, they said. Here’s how lead investigator Stacy Loeb, MD explained it in a press release at that time:

What our study results show is that groups of men who are more likely to get malignant melanoma include those with higher disposable incomes and education—men who likely can also afford more vacations in the sun—and who also have the means to buy erectile dysfunction medications, which are very expensive.

Where does the issue stand today? In June 2018, the Journal of Sexual Medicine published a new report, which we’ll focus on today.

The Groups

Scientists analyzed information from a health records database, finding 610,881 men and women who were prescribed PDE5 inhibitors from 2007 to 2015. (Note: PDE5 inhibitors are used to treat more than ED. Patients of both sexes with pulmonary hypertension and lower urinary tract symptoms (LUTS) may take them, too. That said, in this study, 99.5% of this group was male.) On average, the patients’ first prescription was filled when they were about 51 years old.

The researchers also looked at records from over 2 million people with ED, pulmonary hypertension, or LUTS who were not prescribed PDE5 inhibitors. These people served as a control, or comparison, group.

The Findings

In the group that took PDE5 inhibitors, 636 – a tenth of one percent - developed melanoma. Among people who didn’t take the drugs, 8,711 melanoma diagnoses were made, representing less than a third of one percent of the total group.

The researchers found no link between PDE5 inhibitor use and melanoma in people who had pulmonary hypertension or LUTS. Similarly, no relationship was found for any of the women.

And the men who took the drugs for ED? Interestingly, the researchers did find a link – and not only to melanoma. The authors also reported higher risk for basal cell carcinoma and squamous cell carcinoma, two other types of skin cancer that are more common than melanoma.

However, the authors explained that lifestyle factors could be involved:

Lifestyle factors, namely sun exposure, in this group of men is the likely cause of this increased risk and not the use of PDE5 [inhibitors] given that there is no common mechanism to account for carcinogenesis [formation of cancer] among these varied cancer types.

They added that people who took the drugs for other conditions were not at higher risk for melanoma compared to the non-users with the same health problems.

“Our findings support the safety of PDE5 [inhibitor] use in the United States,” they concluded.

Protect Yourself from Skin Cancer

While the news is encouraging, it’s still important for people to protect themselves from skin cancer, regardless of whether they take PDE5 inhibitors or not. Here are some tips to reduce your risk:

  • Stay in the shade and wear protective clothing, like long sleeved shirts, long pants, and a sun hat.
  • Use liberal amounts of sunscreen (SPF 30 or higher). The American Academy of Dermatology recommends about an ounce of sunscreen – the amount that would fit into a typical shot glass – for the average adult. Wear sunscreen even on cloudy days and reapply every two hours if you’re swimming or sweating.
  • Keep in mind that water, sand, and snow can reflect the sun’s rays.
  • Don’t use tanning beds.
  • Check your skin regularly and see your doctor if you notice anything unusual.

Ask Your Doctor about ED

ED can be treated in a number of ways. If you’re having trouble with erections, call your doctor and schedule a checkup. And don’t hesitate to bring up any questions or concerns.

Resources

American Academy of Dermatology

“Prevent skin cancer”

https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent

“Types of skin cancer”

https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/types-of-skin-cancer

The Journal of Sexual Medicine

Shkolyar, Eugene MD, et al.

“Risk of Melanoma With Phosphodiesterase Type 5 Inhibitor Use Among Patients With Erectile Dysfunction, Pulmonary Hypertension, and Lower Urinary Tract Symptoms”

(Full-text. First published online: June 5, 2018)

https://www.jsm.jsexmed.org/article/S1743-6095(18)30978-0/fulltext

SexHealthMatters

“Study: Chances Are, ED Drugs Don’t Cause Melanoma”

(August 11, 2015)

https://www.sexhealthmatters.org/news/study-chances-are-ed-drugs-dont-cause-melanoma

“More Research Needed on Sildenafil/Skin Cancer Risk”

https://www.sexhealthmatters.org/did-you-know/more-research-needed-on-sildenafil-skin-cancer-risk/resources

“Sildenafil and Skin Cancer Risk”

(June 24, 2014)

https://www.sexhealthmatters.org/news/sildenafil-and-skin-cancer-risk



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