Erectile Dysfunction Medication

Policy

The TAC can pay the reasonable costs of medications used to treat erectile dysfunction when required as a result of a transport accident injury or illness under section 60 of the Transport Accident Act 1986 and when the erectile dysfunction is diagnosed by an appropriate specialist physician or a treating medical practitioner in specific circumstances outlined in this policy.

The TAC will periodically review a client's entitlement to medications used to treat erectile dysfunction to ensure that the treatment remains reasonable for the transport accident injury or illness and is payable under the Act.

This policy must be read in conjunction with the following:

• Pharmacy (Chemist medications) policy 

DEFINITIONS

In this policy:

• Erectile dysfunction is the inability to achieve or maintain penile erection. It is also known as impotence. Erectile dysfunction may occur as a result of injuries sustained in a transport accident/the workplace in the form of neurogenic, vasculogenic or psychogenic origins, or as a side effect of medication used to treat another transport accident injury or illness. 
• Erectile dysfunction medication is medication to treat erectile dysfunction that may be in an oral or injectable form.

GUIDELINES

What can the TAC pay for in relation to erectile dysfunction medication?

The TAC can pay for appropriately prescribed medications to treat erectile dysfunction where the erectile dysfunction is caused by:

• the physical effect of a transport accident injury or illness
• a psychogenic cause directly linked to the transport accident injury or illness
• a side effect of medications used to treat another transport accident injury or illness.

The quantity of erectile dysfunction medication that the TAC can pay for is restricted to the reasonable costs of:

• a maximum of eight intermittent use tablets or injections per month, or
• low dosage daily use tablets (where the medication is indicated for low dose daily use) in circumstances where clinically justified and where written clinical rationale is provided by the appropriate prescribing medical practitioner, as outlined in this policy.

The TAC can only pay for erectile dysfunction medications where:

• the medications are reasonable, necessary or appropriate in the circumstances
• the costs of the medications are reasonable
• the use of the medications is clinically justified, safe and effective
• the medications are registered on the Australian Register of Therapeutic Goods (ARTG).

Who can prescribe erectile dysfunction medication?

The diagnosis and initial prescription of erectile dysfunction medication must be made:

• by a medical specialist such as a Urologist, Endocrinologist, Rehabilitation Physician or Neurologist where the cause of the erectile dysfunction is physical, e.g. urological, neurological, hormonal or vascular damage
• by a Psychiatrist where the cause of the erectile dysfunction is psychogenic, or
• by the treating medical practitioner or a medical specialist where the cause of the erectile dysfunction is considered to be a direct side-effect of medication used to treat another transport accident injury or illness. In these cases, payment for medications for erectile dysfunction will be limited to the period of time the causative medication is required.

After the initial diagnosis and prescription by the appropriate medical practitioner as outlined in this policy, the ongoing prescription of erectile dysfunction medication may be provided by the treating medical practitioner.

What information does the TAC require to consider paying for erectile dysfunction medication?

The TAC requires the appropriate prescribing medical practitioner to provide the information requested in the Erectile Dysfunction Questionnaire in order for the TAC to determine its liability to pay for erectile dysfunction medication.

To expedite payment of accounts, the TAC encourages prior approval be sought by the client's appropriate prescribing medical practitioner.

When will the TAC respond to a request?

The TAC will respond to written treatment and service requests as set out in the TAC Client Service Charter.

What fees are payable for erectile dysfunction medication?

Refer to the TAC Pharmacy (Chemist medications) policy  

In relation to erectile dysfunction medication, what won't the TAC pay for?

The TAC will not pay for:

• treatment or services for a person other than the client
• treatment or services subcontracted to or provided by a non-registered provider
• treatment or services provided outside the Commonwealth of Australia
• treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy 
• treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident.  Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.