Language
English
Publication Date
9-1-2023
Journal
Urology Practice
DOI
10.1097/UPJ.0000000000000416
PMID
37594033
PMCID
PMC12721626
PubMedCentral® Posted Date
8-18-2023
PubMedCentral® Full Text Version
Post-print
Abstract
Introduction: A manufacturer's benefit verification database was evaluated to ascertain United States health plan insurance coverage for implantable penile prostheses for erectile dysfunction.
Methods: All-payer and employer-sponsored health plan benefit verification databases were queried to determine implantable penile prosthesis approval status. For the all-payer analysis, data by payer were available and presented for 2019-2021 to assess approval status varied by payer and over time. For the employer-sponsored health plan analysis, data by payer were available from 2018-2021.
Results: Benefit verification records for the all-payer database were available for 3,167 patients in 2019, 3,016 in 2020, and 2,837 in 2021. Insurance type was preferred provider organization (27.5%), Medicare Advantage (26.9%), Medicare (15.9%), or point-of-service (10.5%). Most patients were approved or verified for implantable penile prosthesis coverage (79.4% in 2019, 79.6% in 2020, and 78.4% in 2021). Coverage was most extensive for government-based insurance (Medicare 98.7%, Medicare Advantage 97.1%, Tricare 100%, and Veterans Affairs 80.0%) but was also favorable for commercial insurance (75.0%). The most common reason for lack of coverage was employer exclusion; the proportion of patients with no coverage due to exclusion increased from 13.5% in 2019 to 17.5% in 2021. Analyses of the employer-sponsored health plan database (n=3,083 patients) showed that 63.1% of patients were approved or verified for coverage and 34.2% did not have coverage due to health plan exclusions.
Conclusions: Approximately 80% of patients had implantable penile prosthesis coverage. Employer exclusion was the most common reason for lagging coverage; rates of employer exclusion increased 29.3% from 2019-2021.
Keywords
Aged, Male, Humans, United States, Penile Prosthesis, Erectile Dysfunction, Medicare, Insurance Coverage, Databases, Factual, erectile, dysfunction, penile prosthesis, insurance coverage, health services accessibility
Published Open-Access
yes
Recommended Citation
Khera, Mohit; Langston, Joshua P; Pollard, Matthew E; et al., "Implantable Penile Prosthesis for Erectile Dysfunction: Insurance Coverage in the United States" (2023). Faculty, Staff and Students Publications. 6184.
https://digitalcommons.library.tmc.edu/baylor_docs/6184