Medicare is paying “grossly excessive” amounts for vacuum erection systems, informally known as penis pumps, which are generally used by men who fail to cure their erectile dysfunction problem with drugs such as Viagra.
That’s the conclusion of a recent report by the Inspector General of the U.S. Department of Health & Human Services, which found that Medicare was paying twice as much for VES (and similar devices) as non-Medicare payers like the Department of Veterans Affairs and Internet consumers.
The inspector general found that from 2006-2011, the government spent $172.4 million on 473,620 claims for these penis pumps, and saw the claims spike during the six-year period. Taxpayers would have saved $14.4 million, and beneficiaries would have saved $3.6 million, during each of those six years if Medicare was paying standard rates.
The IG’s recommendation? Establish a payment limit or seek legislative changes to include VES in the competitive bidding process.
The Center for Medicare & Medicaid Services said it is only overpaying for the penis pumps because the law requires it to.
“Medicare prices for medical equipment prescribed by a doctor are set in statute by Congress,” CMS said in a statement. “In addition, while Medicare strives to pay appropriately for items and services, only Congress has the authority to subject this equipment to competitive bidding program, as the Inspector General recommended. In cases where we have been able to use competitive bidding, the program has saved taxpayers and beneficiaries more than $400 million, and CMS projects savings in the billions over the next 10 years.”
This article has been updated to include CMS’ response.
