Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Boston University Medical Center, Boston, MA, USA.
Int J Impot Res. 2021 Jan;33(1):55-58. doi: 10.1038/s41443-019-0226-8. Epub 2020 Jan 2.
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.
对于所有类别的阴茎假体 (PP)，保险支付者的覆盖范围缺乏统一性。我们试图确定全国范围内来自医疗保健转诊区域 (HRR) 的常见保险计划的常见保险覆盖标准和植入障碍。对勃起功能障碍 (ED) 的病因、ED 持续时间、促成的合并症、药物、药物使用、诊断测试、程序使用和先前干预进行了审查。在 100 个计划中有 70 个包含了覆盖标准。36.1%仅在性别焦虑症的情况下提供覆盖。27.7%需要记录药物治疗的试验、禁忌症或不耐受性，并且对其含义有不同的描述。13.8%至少需要考虑之前的药物治疗。4.2%需要对经典二线治疗进行试验或禁忌症。25.0%表示 ED 必须是器质性的。心理性 ED 由 12.5%的计划承保。11 个计划要求至少有 6 或 12 个月的症状。为了排除性腺功能减退症或高泌乳素血症，有 5 个计划要求进行实验室评估。PP 放置的保险覆盖标准因州和计划而异。在药物治疗失败后，对于由合并症最佳管理的器质性病因引起的 ED，大多数情况下都可以提供 PP 植入的保险。
