Medicare covers vacuum erection treatment devices for gentlemen with Organic Impotence as a result of one or more of the following conditions:

    - Carcinoma of the Prostate
    - Hypertension
    - Carcinoma of the Bladder
    - Spinal Cord Injury
    - Peripheral Vascular Disease
    - Colorectal
    - Non-Insulin Dependent Diabetes Mellitus
    - Insulin Dependent Diabetes Mellitus

You can view and print the RX Order Form that is required by Medicare by simply clicking here. The Prescription System covered by Medicare will have a price of $493.96 (Medicare allows ~$460 depending on your state) and will be provided through Bonro Medical, the manufacturer. Please contact Bonro Medical at 1.877.266.7699 for questions regarding your insurance or Medicare coverage.

Then use the print option on your browser to print this form on your printer, fill in the appropriate fields and take it to your physician. Once completed, please mail or fax the form back to us (many ask their doctor's office to fax it directly to us). All prescription orders are fulfilled with the Prescription Version of the VacuRect System.

If you do not have Medicare coverage or wish to purchase the system now for expedited delivery, click here to return to the product page.

We also have professional medical advisors available during normal business hours that can discretely discuss any questions you may have. Call us at 1.866.813.6321.