A look at Medicare's 'grossly excessive' spending on ... penis pumps

Distinguished legal minds of the U.S. Supreme Court will soon hear oral arguments over whether the federal government can compel businesses to cover contraceptives at no cost to women through the Affordable Care Act.

It’s a serious issue. And Comedy Central’s The Daily Show is all over it.

Correspondent Samantha Bee took viewers into the debate in a segment host Jon Stewart described as the rare intersection of health care, the economy, aging and penises -- "the issues of greatest consequence to you, the American people."

Some conservatives and Catholics argue the contraceptives mandate violates the religious rights of business owners who would have to provide coverage for a medication they do not agree with, and that women who want it should get it on their own.

Bee sat down with Ilyse Hogue, president of NARAL Pro-Choice America, a group that supports birth control and the morning-after pill being made available to everyone. Hogue said women use birth control for a number of reasons, including avoiding unintended pregnancies, regulating menstrual cycles and treating endometriosis. The contraception mandate addresses a disparity with the federal government paying for men’s sexual health treatments, she argued.

"The existing system is absolutely a double-standard," Hogue said. "Medicare has spent $172 million on penis pumps in the last five years at $360 a pop."

Bee considered the information. "Wait, Medicare funds penis pumps?"

Truth be told, we were curious too. Can Hogue’s numbers be right, or are they inflated?

"Vacuum erection systems" (that’s a more technical term) are one of several ways a man might treat erectile dysfunction, which affects 30 million men, according to the National Kidney and Urologic Diseases Information Clearinghouse.

We found an inspector general report from the Department of Health and Human Services detailing the issue. (A spokeswoman for NARAL Pro-Choice America later pointed us in the same direction.)

Featured Fact-check

Joe Biden

stated on April 9, 2024 in an interview with Univision

Starting in 2025 "no matter what your total bills are for prescription drugs,” Medicare Part D users will never pay “more than $2,000 a year, because some of these cancer drugs are 10(,000 to) 15,000 bucks a year.”

The December 2013 report didn’t weigh in on whether it was inappropriate for Medicare to pay for penis pumps. The crux of the review was to find out if Medicare was paying exorbitant rates for them.

The devices are among medical supplies eligible for Medicare Part B, which offers supplementary health insurance for medically necessary and preventive services for seniors. The cost of a device like a penis pump is subtracted from a beneficiary’s deductible, and Medicare picks up 80 percent of the cost after that.

The auditors’ findings: Medicare payments for vacuum erection systems are more than twice the average payment rate for non-Medicare payers. The difference is "grossly excessive," the report says.

From 2006 to 2011, Medicare paid a total of $172.4 million for 473,629 claims for pumps, or about $364 a pump. That’s almost exactly what Hogue said (though spending was measured over a six-year period ending in 2011, not the last five, as she said). Over those six years, annual claims payouts almost doubled, jumping from $20.6 million in 2006 to $38.6 million in 2011, the report says.

Medicare would save $18 million a year, and its beneficiaries would pocket $4.5 million, if the program retooled its fee schedule rate to be more in line with other programs and the private market. The report suggests the Centers for Medicare and Medicaid Services either establish a payment limit or to seek authority from Congress to include the products in its competitive bidding program.

Our ruling

Hogue said, "Medicare has spent $172 million on penis pumps in the last five years at $360 a pop."

We’ll stay out of saying whether it’s legitimate for Medicare to cover vacuum erection systems for older men, and whether it’s unfair that many health plans would have to cover contraception. The Daily Show was trying to make a humorous point about tax money paying for some male sexual health products, which hasn’t been a source of controversy.

As for Hogue’s statement, she gets the dollars right but misses on the timeframe. An inspector general’s report measured six years ending in 2011, not the most recent five years.

That’s a minor point in judging her overall claim. We rate Hogue’s statement Mostly True.