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State moves to stop coverage for erectile dysfunction

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By NATE JENKINS / The Associated Press

Tuesday, Jun 17, 2008 - 04:11:34 pm CDT

Poor Nebraskans seeking treatment for erectile dysfunction may soon be turned away by state government.

State officials are proposing state Medicaid rules be changed so that the insurance program does not pay for penile implants.

State Medicaid director Vivianne Chaumont said the change is consistent with a federal rule, approved in 2006, that barred the federal government from spending Medicaid dollars on erectile dysfunction drugs including Viagra. Nebraska followed suit a few months later and changed its rules to keep state Medicaid money from being spent on the drugs.

Story Photo
Vivianne Chaumont

The federal government will still help pay for penile implants in states that choose to continue covering the procedure under their Medicaid plans.

“The decision was made not to cover the drugs, so it’s ... a good idea to have particular procedures for prosthesis not covered as well,” Chaumont said.

Medicaid is meant to pay for the medical necessities of needy people and “sex is not medically necessary,” she said.

Unlike other, current proposals in the state to reduce coverage for dental services, eyeglasses and hearing aids, among others, removing erectile dysfunction from the Medicaid list is not meant as a cost-cutting measure.

Three Nebraskans have had penile implants paid for by Medicaid since 2003, with Medicaid picking up $11,705 of the costs, according to the state Department of Health and Human Services.

The exact cost to the state could not be figured, spokeswoman Marla Augustine said, but the state normally funds 40 percent of Medicaid. The federal government pays the rest.

Dr. Ira Sharlip with the American Urological Association said the proposed rule change is unfair to poor men who can’t afford the treatments and raises issues of gender equity.

The condition, he said, can be “devastating psychologically,” leading to depression and marital problems.

“It is not logical to me or seem fair to deny poor people from having access to safe and not very expensive treatments,” said Sharlip, a professor of urology at the University of California in San Francisco.

A substantial percentage of men with erectile dysfunction have it as a result of prostate cancer. He compared that link to women who have their breasts removed as a treatment for breast cancer.

Federal law requires many insurers who pay for mastectomies to also pay for breast reconstruction, Sharlip said.

Nebraska is not required to cover breast reconstruction under its Medicaid program, but does so anyway.

“At the very least, to provide for gender parity, men who have ED as a result of prostate cancer should be provided treatment under Medicaid,” Sharlip said.

Chaumont, who moved to Nebraska about a year ago to take her current position, said she didn’t know why the decision was made to cover breast reconstruction under Nebraska Medicaid but added that it didn’t strike her as unreasonable.

“I don’t think breast cancer has anything to do with sexual dysfunction or sexual impotence,” she said.

Asked why it is important to cover breast reconstruction, she said that doing so “is in line with other insurers.”

A hearing on the proposed rule change is scheduled for July 10.


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ha ha ha wrote on June 17, 2008 1:06 pm:
" ha ha ha. This is so good it just has to be fattening. Oh man oh man classic "

 Linda wrote on June 17, 2008 1:14 pm:
" I'm REALLY sick of the TV commercials too! "

 Rye wrote on June 17, 2008 1:18 pm:
" How can they say sex is not medically necessary...let's have them all lose their sexual function and see how they feel both mentally and physically! "

 CS wrote on June 17, 2008 1:21 pm:
" I believe that there are many mental health professionals that might beg to disagree. "

 JT Hutt wrote on June 17, 2008 1:21 pm:
" Because being poor isn't depressing enough, now the state is saying that they won't help one of life's most basic behaviors. Is there such a drain on resources from droves and droves of men filing claims? Apparently intimacy problems only affect men so sorry wives, you must be imagining any problems from lack of intimacy with your spouse. "Sex is not medically necessary" "

 SJL wrote on June 17, 2008 1:34 pm:
" You know it is about time I am tired of paying for others people's "PROBLEMS" while no one has ever helped me with mine. You know my insurance coverage won't cover birth control....so I have to pay for my own plus someone elses and you want to pay for some man's ED! I SAY NO WAY! "

 Larry wrote on June 17, 2008 1:34 pm:
" "sex is not medically necessary" No sex - No Babies??? How do these officials get these jobs and where do I apply... "

 peb wrote on June 17, 2008 1:39 pm:
" And you know, those Viagra sales spam emails make it through all the fire walls!

". . . unfair to poor men who can’t afford the treatments. The condition can lead to depression and marital problems." Boo Hoo!

What about all the years birth control has not been covered by insurance? "

 FT wrote on June 17, 2008 1:47 pm:
" If I can't afford something, then I go without. I'd like to get Lasik but my insurance (which I pay for) doesn't cover it and that's the way it is.
Just because a person goes to work every day and has a good job doesn't mean we can afford everything we want. Why does everyone feel like they're entitled to everything? "

 t wrote on June 17, 2008 1:52 pm:
" Going to work every day seems to be a basic human behavior too and many don't partake in that either. Furthermore, job or not, one can still be a productive citizen or volunteer, and being busy staves off depression. "

 me wrote on June 17, 2008 1:56 pm:
" well if you have to have your ED paid for by the state then you shouldnt be having kids. so, im 100 lbs overweight and its really straining my self confidence, can i get the state to pay for lypo since im on medicaid and havent been able to find work in over a year? "

 Grundle wrote on June 17, 2008 2:06 pm:
" How is treatment for E.D. being compared to birth control? The last time I checked, women don't need birth control to engage in sexual activity, by that I mean, women can fully engage in sexual activity without the use of contraceptives. As for men, it's pretty difficult to engage in sexual activity if you can't...err...raise the flag, so to speak. "

 Josh wrote on June 17, 2008 2:08 pm:
" I am surprised all the bible-thumpers haven't been protesting this all along. Penile implants are against the natural order and I am sure it is banned in Leviticus somewhere... "

 James wrote on June 17, 2008 2:28 pm:
" This is a penetrating issue and the state of Nebraska has really gone limp on the upstanding needs of it's citizens and really left them hanging! I know they are trying to be firm in their position and not be judged as flaccid in their views, but the outcome can only be interpreted as hard on the people who need help with this prickly medical problem. I fear that the powers that be in this state only showed themselves to be weeners with this one! Let's all roll up our sleeves, get ahold of ourselves, use our heads and re-examine this probing question carefully. This is no time to be small and dorky about this! "

 Quit complaining wrote on June 17, 2008 2:40 pm:
" You know, it is about time. If you cant get it up than you can't get someone pregnant which means that there is one less person to have worry about the state having to pay for there medical bills. I think Ms. Chaumont is doing the right thing and should be applauded for it and not criticized because some man cant get any from his wife or significant other. This isnt a medical necessity that should be covered by hard working tax payers money. "

 Kevin wrote on June 17, 2008 2:44 pm:
" Wow...three people in 5 years. Think of the savings! "

 Cruel wrote on June 17, 2008 2:48 pm:
" The State, through its grace, has decided to offer health care to poor people. Now the State, without much grace, has the right to pick and choose what it will and will not pay for, but it seems terribly cruel to me. "

 JUST SO YOU KNOW wrote on June 17, 2008 3:06 pm:
" Grundle: Just so you know, birth control helps regulate a lot of medical issues. It alleviates PMS symptoms (of which ALL men appreciate), it aids in the severity of abdominal cramping and pain, it regulates the menstrual flow as well as in a lot of women has other beneficial components. I have been on BC for years to treat the crippling pain many women just deal with due to the cost, having NOTHING to do with sexual activity. So, please don't be so quick to judge. "

 John Holmes wrote on June 17, 2008 3:12 pm:
" I've got to hand it to Ms. Vivianne she really knows how to take the bull by the horns. Another chance for the government to deflate the citizens. "

 Jen wrote on June 17, 2008 3:21 pm:
" Maybe if these people did not suffer from hypertension and diabetes they would not need Viagra or Cialis. "

 Dear Grundle wrote on June 17, 2008 3:24 pm:
" You're missing the point about birth control. This upsets us, because who gets stuck with the responsibility of a birth, ultimately? And that's not all covered by insurance, so don't you think insurance should pay for one or the other? For a man to get services that will allow for him to have sex, --possibly irresponsibly creating more fatherless children, why wouldn't females be offended by this? Duh. "

 Really wrote on June 17, 2008 3:27 pm:
" Seriously--you guys don't understand the point that sex is not 'medically necessary'? Okay, I'll explain. You won't die if you don't have sex. No, you really won't. The purpose of sex, from my puny understanding, was to procreate. A person does not NEED to procreate. I've chosen to abstain for several years. I'm still here. "

 Grundle wrote on June 17, 2008 4:02 pm:
" Why should females be offended by this? There are other methods of contraceptives that the male can use that are very effective...those methods aren't covered by insurance or the state either. Apples and oranges...you can't compare the ability to have sex with the products of sex. I realize that birth control can help with a variety of medical issues, but again, none of those symptoms physically prevent women from engaging in sexual relations. The reproductive organs of a woman don't stop functioning without birth control...but male reproductive organs have been known to fail to function completely. Even without birth control, women can engage in sexual activity sans a partner. Men with E.D. do not have that same ability without treatment. "

 JK wrote on June 17, 2008 4:07 pm:
" Want ED treatment? Get a job! "

 right on Rye wrote on June 17, 2008 4:55 pm:
" Once again the poor must suffer. You are absolutely correct that mental and physical health can be linked with a good sex life. "

 UncleMike wrote on June 17, 2008 5:12 pm:
" There is a big difference between not having sex and not being capable of having sex. If Ms Chaumont could experience all the things that Prostate Cancer does to your body, and to your mind, she might reconsider ED treatment. The real problem isn't that Implant is covered, but that ED Drugs are not. Expecially if the cause is Prostate Cancer treatment. "

 Soylent Green wrote on June 17, 2008 5:56 pm:
" It's a pretty sad state of affairs when, in the richest, allegedly greatest, nstion on earth we start picking and choosing who is deserving of what treatment for which medical conditions. I predict, however, that this is just the beginning of the process of cutting out specific medical proecedures for Medicaid recipeients. Perhaps we'll soon see formulas in place where a person's lifetime earnings, potential for future productivity and earnings, plus the state tax revenues they generate will be fed into a computer for a calculation of the cost-benefit ratios of keeping that person alive. Those with the lowest ratios could be just shut off entirely. It's time for universal single-payer health care. "

 Cary wrote on June 17, 2008 6:27 pm:
" This is a Dark Age position Chaurmont has taken. Sex remains a basic part of the psychological physiologic foundation of healthy individuals. There surely is a professional health board who should be examining her irrational position. It is surprising pharmaceutical companies aren't taking this to court! "

 O. C. Jones wrote on June 17, 2008 8:23 pm:
" Medicare/Medicaid will pay for a woman's breast reconstruction after breast cancer surgery. But they don't want to pay for ED drugs or penile implants for men who have had surgery or radiation for prostate cancer. "

 toasted wrote on June 17, 2008 8:29 pm:
" For everyone who believes that universal health care will solve all of our problems...look at Denmark. Denmark has universal health care, but the income tax is 50%. Do you want 50% of your income taken by the government? I didn't think so! "

 Level Headed Jim wrote on June 17, 2008 8:57 pm:
" I'm fine with giving out more Medicaid benefits -- just as soon as the U.S. is back in the black. We only have to cut about $5 trillion to get there. Any of you liberals willing to pay a little more of your income to Uncle Sam? "

 CS wrote on June 17, 2008 8:57 pm:
" Did you spend a WHOLE 5 minutes looking on the internet for the worst possible taxation example in a country with universal health care? Didn't bother to mention the year+ paid paternity and maternity leave, lower stress level, higher incomes, weeks longer of vacation, and state paid for education through college did you? "

 Heart Risk wrote on June 17, 2008 9:01 pm:
" I had a friend who has ED. Due to the heart medication he was on after his heart attack, he could not safely take Viagra. Just because he could not get an "E" did not mean he couldn't have an "O." He is fixed and past the age of reproducing at any rate. A penile implant would not be about making babies. But it might make him a bit less grouchy, which would be good for everyone! It seems to me there are devices which could be inserted temporarily and removed when finished. "

 Dale Kaup wrote on June 17, 2008 9:18 pm:
" ED drugs should be available to men who need them. If they are expensive then go after the drug companies who price the drugs much higher in the United States than elsewhere. "

 TWP wrote on June 17, 2008 10:14 pm:
" Welcome to the world of government provided health coverage. Be careful what you wish for. Today, the government tells you that you don't need to have sex. Tomorrow, they will tell you how big your waistline can be (see Japan). "

 kelly wrote on June 17, 2008 11:01 pm:
" Chaumont is, again and always, the Governor's hatchet. While we work so hard to improve recovery in other areas, this administration is busy undermining the whole thing. The Governor is going to cut costs, no matter who it hurts in the longer term. The fact that this is related to s-x just makes it all the better target....afterall, it's an administration that still can't use the word s-x in program titles. "

 john wrote on June 17, 2008 11:08 pm:
" This administration is nothing but a bunch of bigots. That's all it is. They slice the population into little minorities, then play them against one another, deny one this, while they play it up to another... Doesn't anyone see the shell game that's going on? All in the name of saving money for you, your government is fleecing your neighbor-or, is it the other way around. "

 Ziiiiiiiiiiing wrote on June 18, 2008 2:32 am:
" If you have ever HAD sex, then you know its medically necessary. "

 Nina wrote on June 18, 2008 7:43 am:
" A good enough reason for breast reconstruction is to maintain the body's balance, to prevent falls from losing one's balance while walking, etc. I would think that before erectile dysfunction would be covered, insurance should cover eyeglasses and hearing aids. It is more of a priority to be able to see and hear than it is to perform sexually. "

 Citizen wrote on June 18, 2008 8:31 am:
" I think everyone is miss in formed. My husband has ED. We both have jobs to pay for things like viagra. If we were unable to afford it we would have to go without. We have insurance but the insurance doesn't cover it. We certianly are not wealthy but I'm not complaining about it. I don't feel like the gov. should pay for everything either. I work in the health ins industry and hear people complain all the time that something isn't covered. Health ins was not meant to cover everything. We as a society have to be more responsible not expect handouts. I'm shocked so many think this should be covered under medicade. "

 OmahaAnnie wrote on June 18, 2008 9:04 am:
" I can't believe and did not know that this was something that the state paid for. I wonder how many children were born from penile implants and if so, I can't believe that someone hasn't sued the state claiming that without the states interference, the child would not have been born, and the child is now the states responsibility.
God help our country. "

 I have wrote on June 18, 2008 9:07 am:
" to agree with some of the comments about going to work. I know to many people who know how to work the system to be a stay at home person. After working over 45 years , sometimes two jobs, I thought I'd retired. Now, with the high cost of everything, it ain't possible. I have seen people with severe disabilitys working. Some people just don't want to earn their way. It's to easy to sit on the couch, collect what the government wants to give them, and let someone else pay their way. As far as medicaid giving them e d drugs, in countrys where they have national health insurance, if its not a true medical condition, they have to pay their own or get another supplement insurance. There are to many babies from one night stands. "

 Total Coverage wrote on June 18, 2008 10:21 am:
" So what if 50% of our income is taken in taxes. The government already takes 30%. Considering you'd never have to pay a deductable, I think you'd come up paying less overall in the long term when you factor in children, glasses, family members in poor health, pregnancy, dental care, and anything else. For a little more in taxes, me, my spouse, my children, and my family would never have to worry about medical hardship ever again. Also, you'd never have to put up with any insurence nonsense. I WOULD say 'thank you'. "

 Grundle wrote on June 18, 2008 10:24 am:
" I'm a bit dismayed at some of the assumptions and accusations being tossed around. First of all, Medicaid is not providing coverage for E.D. drugs, which is clearly stated in the article. They are only covering the implants...and we're talking about 3 procedures amounting to less than $12,000 in the past 5 years. Secondly, where is the evidence that the men who received treatment are fathering illegitimate children? What is the basis for such an accusation? Finally, I scoff at the idea that breast reconstruction surgery, which probably bilks WAY more off of the Medicare/Medicaid system, is somehow more deserving of coverage. I'm not going to argue that such surgery is less deserving, I believe that they are equally deserving. Dr. Sharlip is absolutely correct...this is a matter of gender equity...and for Ms. Chaumont seek denial of this treatment for men, while not seeking to deny women treatment for breast reconstruction seems a bit Chau-vinistic to me. "

 Imagine That wrote on June 18, 2008 11:40 am:
" Well go figure an agency such as state Medicaid doing something like that
it seems to me that they should focus on real problems with the system.
I have a father in a nursing home and medicaid dont even pay for his medication that is a must have but yet people complain about implants go figure.Quit your whining. "

 Lollerskates wrote on June 18, 2008 1:41 pm:
" No surpise that a woman made this decision. "

 cost effective wrote on June 18, 2008 4:19 pm:
" The way I see it, birth control prevents the birth of a child whose parents can't even pay for their own healthcare, much less the child's. Plus, the cost of delivery and pre-natal care is nothing to sneeze at either. Covering birth control can prevent some of these expenses, but I really can't think of any way that covering ED meds has any cost benefit for the medicare system. "

 Sex Equity in Sex Policy wrote on June 19, 2008 12:48 pm:
" To be fair, the following E.D. policies should be implemented:

1. Requirement that abstinence-only literature be distributed first.
2. Spousal Notification and approval of sexual performance drugs or erectile disfunction procedure.
a. Judge can overrule if conditions apply.
3. Procedure and drugs can only be obtained out-of-state.
4. Federally funded Erectile Disfunction Clinics can be set up across Nebraska to mourn the guilt felt by the loss of important male fertility components. "

 about the drugs wrote on June 24, 2008 11:06 am:
" People always complain about the drug companies, and how much the drugs cost, but they do not understand all of the work and money that goes into formulating 1 drug. Companies spend upwards of $100 million just to formulate 1 drug. There must be series upon series of tests done to ensure the medicine you recieve is actually safe. These tests take around 10 years to complete. The reason why drugs cost so much is because the companies must make all of that $100 million back within an 8-10 year period before their patent is expired. If they lose money on only a few drugs, than it is likly they will go out of business and you wont have any prescription medicines at all. Once the patent is expired than the drug can become generic, and the costs become cheaper. I know it is no consolation, but if people can wait a few more years, I will be willing to bet that a generic form of Viagra will come out and more people will be able to afford it. "

 Grax wrote on June 24, 2008 12:30 pm:
" "about the drugs" makes a partially valid point. however, what this means to us is that basically all research into medical treatment options goes into creating patentable drugs and marketing those drugs. There is no one to pay for research and marketing for beneficial foods, exercises, and lifestyle changes. I understand why there isn't, I just think it is a pity. "

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