Is Viagra covered by insurance?
Key takeaways
Viagra, a well-known medication for erectile dysfunction, exhibits inconsistent insurance coverage, with generics generally enjoying a higher likelihood of being covered.
Medications for erectile dysfunction, including Viagra, may yield health advantages that transcend enhanced sexual performance, potentially benefiting men’s mental, emotional, and cardiovascular well-being.
Medicare Part D often excludes Viagra from coverage, though certain Medicare plans may cover generic alternatives or similar medications prescribed for conditions such as pulmonary arterial hypertension.
Strategies for mitigating the cost of erectile dysfunction medications include buying in larger quantities, selecting generic formulations, or utilizing prescription discount programs such as SingleCare.
Viagra is a widely prescribed medication designed to address erectile dysfunction (ED), aiding men in enhancing their sexual health and relationships for over two decades. While ED is a prevalent condition—estimates indicate there will be around 322 million cases globally by 2025—the price tag for Pfizer’s “little blue pill” remains daunting, averaging over $100 per tablet.
Despite the low likelihood that insurance, Medicare, or Medicaid will cover Viagra and many other ED medications, several options are available to help make the expense of erectile dysfunction treatments more manageable.
Commercial health insurance policies consistently exclude brand-name ED medications like Viagra, Cialis, Levitra, and Stendra. Instead, insurance plans are more inclined to cover generic versions of these medications (sildenafil, tadalafil, vardenafil), should they be included in your plan’s formulary. Even if these drugs are present, it’s important to note that there may be limitations on coverage, such as requiring prior authorization or implementing quantity restrictions.
If your health insurance plan includes coverage for any of these medications, anticipate that you will still incur a copayment, though the exact amount will vary based on your specific plan. It’s wise to clarify with your insurance provider regarding the copayment cost associated with your medications.
Before making any decisions about ED treatments, speak with your primary care physician or a urologist, as the most suitable medication for you will depend on your health history, lifestyle factors, and any concurrent medications.
Does Medicare cover Viagra?
Currently, most Medicare prescription plans do not provide coverage for brand-name Viagra. A few Medicare drug plans may cover generic erectile dysfunction medications, but typically only when they are deemed medically necessary and prescribed to address other health issues beyond erectile dysfunction. For instance, generic Cialis (tadalafil) could be covered if prescribed for BPH, or Medicare might cover Revatio (sildenafil), which is used to address pulmonary arterial hypertension.
It’s crucial to examine each Medicare plan’s formulary, which is a list of covered medications, before selecting a plan. Utilize the Medicare Plan Finder to identify plans that include coverage for ED medications.
Please note: Medicare Part B may encompass coverage for various ED-related services, including examinations, diagnostic assessments, penile implant surgeries, and Coloplast devices.
Does Medicaid cover Viagra?
Similar to Medicare, Medicaid frequently does not provide coverage for Viagra or other erectile dysfunction drugs, as they’re typically categorized as lifestyle prescriptions and not considered “medically necessary.” However, if prescribed for medical conditions apart from erectile dysfunction, generic options for these medications might be eligible for coverage.
It’s essential to understand that Medicaid policies can differ significantly from one state to another, so it’s advisable to consult with your specific state’s Medicaid program before dismissing this option.
How to save on Viagra
As we've established, if you require Viagra, you cannot always rely on financial support from your insurance provider or Medicare, and the cost of brand-name Viagra can be excessively high. Nevertheless, even in cases where your insurance does not cover the medication, there are numerous strategies to access erectile dysfunction treatments at a more affordable rate. You merely need to become familiar with several helpful tactics.
1. Use SingleCare
SingleCare is dedicated to making prescriptions more affordable for everyone. Whether you have insurance coverage or are uninsured, SingleCare can discover the lowest prices available at your nearby pharmacies, allowing you to utilize coupons to further decrease your out-of-pocket costs. The service is completely free. For instance, with SingleCare, the generic version of Viagra costs around $11.51 for 30 tablets at 100 mg, while generic Cialis may cost about $15 for 30 tablets at 20 mg.
2. Ask your doctor for a larger quantity
Buying medications in bulk often results in a lower price per unit, and this concept extends to prescriptions as well. Purchasing a larger quantity, such as 10 pills at a time, will typically yield a significantly reduced price per pill compared to acquiring them individually. Even if your insurance or Medicare Part D covers your medications, larger prescriptions can still help you save money. Since copayments are incurred each time you fill a prescription based on your deductible and pill count, reducing the frequency of refills can lead to fewer copayments over time.
If this route appeals to you, discuss changing your current prescription with your healthcare provider.
3. Ask for a generic version
Generic alternatives to Viagra, Cialis, or Levitra are not only more likely to be covered by insurance plans, but they are also generally much more affordable.
For example, when considering sildenafil, the generic counterpart of Viagra, it costs approximately $1,394 for 30 tablets at 100 mg, while the brand-name version retails for roughly $2,867 for the same quantity. This price disparity is significant, highlighting the advantages of opting for generic medications. The same principle applies to tadalafil (generic Cialis) and vardenafil (generic Levitra) as well.
4. Switch to a cheaper brand
It’s worth noting that alternative ED medications tend to have varying price points, and in some cases, drugs like Cialis or Levitra may prove to be more budget-friendly than Viagra. However, always consult with your healthcare provider before starting a new medication.
RELATED: Alternatives to Sildenafil and how to adjust your prescription
5. Treat the underlying cause
It’s important to recognize that erectile dysfunction can often be a symptom indicative of other medical issues, such as hypertension or diabetes. Insurance companies, Medicare, and Medicaid are significantly more likely to provide coverage for drugs that treat these underlying health concerns rather than purely for erectile dysfunction itself.
RELATED: Understanding the causes of erectile dysfunction
Certain medications may also lead to erectile dysfunction as a side effect. Consider consulting your healthcare provider to go over your current medications for any potential contributors to your ED.
Moreover, erectile dysfunction may be alleviated or addressed through lifestyle modifications and natural remedies, including smoking cessation, stress handling, physical activity, and proper nutrition. If your health insurance does not cover erectile dysfunction medications, exploring alternative treatment methods could be a beneficial path.