Erections and insurance

1. My insurance covers 8 pills for ED inflicted by a surgery or injury that was done and covered under my policy. For ED of any other form, no coverage at all. This is 8 pills, regardless of type or dose. So I get 8 20mg Cialis and cut them up to get a daily dose of about 5mg.

Other guys here report 5 pills and some, no coverage at all. Trimix is really iffy. My insurance denied it multiple times as not medically required, but with some assistance from a pharmacy, it was finally covered as 10ml per month.

2. Wow. 40% at 4 months out is GREAT.

3. Dr. Mulhall (google his "Saving Your Sex Life" - John P. Mulhall, MSKCC) has a chart that implies injections could start as early as 6 weeks after surgery if pills don't work (explain to me how anyone 6 weeks out could have tried all the pills often enough to give up on them?), but my uro says not before 3 months.

I would try all the pill variations first. Ask your uro or GP for samples of all of them. The logistics of a pill are so much easier than injections.

That said, your uro should expect you to have a "training" session, where you inject with the real stuff, and see how you react. Mulhall requires 2 sessions. That will require that you get the prescription, find a compounding pharmacy, get the coverage questions sorted out, and get it made/ shipped. That took me 5 weeks, so if you have a "deadline", talk to your uro now and get the ball rolling. If you wind up with Trimix you don't need, it will keep in the freezer for up to 6 months.

RT likely won't do anything to erectile function at the beginning, so don't look at day 1 as the end.

Thanks for the thoughtful replies, guys.

I'm going to call my uro and set up an appointment for injections. Last time I saw him he mentioned using a pump, but from what I've read it leaves a lot to be desired.

142, I have read Mulhall's book which is what got me asking more questions about rehab. Interesting how one uro sees the importance of early rehab while others don't even mention it (my uro/surgeon said it would take up to a year to regain function, and that was it).

As to the pump, my insurance allowed it after more than a little hassle over in-network/out-of-network, durable medical device, etc. I did have to pay a co-pay, and the shipping, but since I blew out all the maximums that year on RT, it was a wash. Spend it here, spend it there ...

Is it helpful? I have read that some uros say no (mine is not impressed with trying to use it for intercourse, and I would agree), and others are all for it. Mine had the opinion that if I was using it to stretch tissue (prevent atrophy by pumping up, holding for 10 seconds or so, release, let it go down, then the same again), and had no other expectations, it is a tool. I've since read another book by a surgeon who is pretty much middle of the road who suggests that a lot of the ED issues come from buildup of plaque, much like that in the arteries, that slowly degrade function. He promoted use of the pump and injections at intervals to break up any deposits that might be forming. I've been diligent about it, and can say that with a shot of trimix, I see no loss of size or length that others complain about.

So it seems to be like a lot of the things people suggest - if you buy and use one, you may not know if it really helped, but at least you are doing something.

My insurance theoretically offered to pay for a "Vacurect" pump but it would have cost 2 1/2 times as much and would have gone against my out-of-network deductible. There are two models of the device, one requires a prescription and costs a lot and the other is a consumer model that is much less expensive. While my in-network deductible for my insurance is long since past for this year, all of my doctors, hospitals, etc., seem to be in-network and I would have been unlikely to ever see a dime from the insurance for the $500 device which is functionally identical to the $195 "non-prescription" model. The only difference between the two versions is that the prescription model comes with more rings and a bigger bottle of lube, and it comes in a black travel case, while the consumer model has exactly the same device w/ fewer rings and it comes in an (admittedly stupid looking) green travel case. So I ignored my insurance, coughed up two hundred bucks and left the other three hundred in the bank.

My take on the VED vs Injections thing is that you should do both, or if you get some results with PDE5i drugs all three -- on different nights. The research I have seen seems to show that pills and pumping works better than just pills for penile rehab and that pumping between injections does better than two or three-times-a-week injections alone. VEDs are not as good as a single therapy but they play nicely in combinations.

The nice thing about the pump is that there is almost no per-use cost. Unless your insurance buys them the pills are ten to twenty dollars a pop. Trimix is about half that. Pumping (after you buy the device) is almost free. Another advantage of the pump (and particularly the Vacurect where you pump with the ring on) is that if you are struggling with incontinence the ring keeps you dry during the act.