Is Viagra Covered by Insurance?
Key takeaways
Viagra, a popular drug for erectile dysfunction, has variable insurance coverage, with generic versions more likely to be insured.
Erectile dysfunction medications, including Viagra, can offer health benefits beyond improving sexual activity, potentially affecting men’s mental, emotional, and heart health.
Medicare Part D does not typically cover Viagra, but some plans may cover generic versions or similar medications for conditions like pulmonary arterial hypertension.
There are strategies to reduce the cost of erectile dysfunction drugs, including purchasing in bulk, opting for generic versions, or using prescription discount services like SingleCare.
Viagra is a widely prescribed medication used to treat erectile dysfunction (ED). This drug has assisted men in improving their intimate lives for over two decades. Despite the prevalence of ED — with projections suggesting that 322 million men globally could be affected by 2025 — the costs associated with Viagra can be quite steep, averaging over $100 per pill for brand-name versions.
Even though insurance providers, Medicare, and Medicaid frequently do not cover Viagra or many competing ED medications, there are numerous methods to make treatment more economical.
Typically, commercial health insurance plans do not extend coverage to brand-name ED drugs like Viagra, Cialis, Levitra, and Stendra. However, insurance is often more inclined to cover generic alternatives to these drugs (sildenafil, tadalafil, vardenafil). It’s important to note that even when these medications appear on your health plan's formulary, coverage may come with restrictions, such as the need for prior authorization or limits on prescription quantities.
If your health plan does provide coverage for any ED medications, you will likely still incur a copayment, which varies based on your specific insurance plan. When discussing coverage with your insurance provider, be sure to inquire about the copay amounts associated with your prescriptions.
Consultation with a primary care physician or urologist is crucial when evaluating options for ED medications, as the effectiveness of a drug can depend significantly on individual health history, lifestyle factors, and any other medications currently being taken.
Does Medicare cover Viagra?
Generally, Medicare prescription plans do not cover brand-name Viagra. While some Medicare plans may extend coverage to generic ED medications, this is often conditional upon the medication being deemed medically necessary for treating other health conditions, rather than for ED itself. For instance, generic Cialis (tadalafil) could be covered when prescribed for benign prostatic hyperplasia (BPH), and Medicare may cover Revatio (sildenafil) for pulmonary arterial hypertension.
Before selecting a Medicare plan, it's critical to review the formulary (the official list of covered drugs) as this can greatly influence your coverage choices. You can use the Medicare Plan Finder to help identify a plan that includes coverage for ED medications.
Additionally, note that while Medicare Part B may not cover ED medications, it might provide coverage for associated services such as exams, diagnostic tests, and surgical options like penile implants.
Does Medicaid cover Viagra?
Similar to Medicare, Medicaid frequently does not cover Viagra or other ED treatments because they are often classified as lifestyle drugs rather than medically necessary prescriptions. However, exceptions may apply if a patient is prescribed generic versions of these medications for non-ED related health issues.
Keep in mind that Medicaid policies differ dramatically between states. Therefore, it’s advisable to contact your specific state’s Medicaid program to clarify what medications are covered.
How to save on Viagra
Given the consensus that insurance may not be a reliable source for covering Viagra and that the price for brand-name versions can be prohibitively high, it’s beneficial to explore alternative methods to obtain erectile dysfunction medications at a reduced cost. Implementing a few strategies can make obtaining these drugs more financially feasible.
1. Use a discount prescription service
One popular option is utilizing a discount service like SingleCare, which is designed to provide cost savings on prescriptions. Whether you have insurance or not, SingleCare can help you locate the lowest price for medications at local pharmacies and offer coupons to further decrease costs. For instance, with SingleCare, generic Viagra can be priced as low as $11.51 for a 30-pill supply of 100 mg tablets, while generic Cialis may be available for around $15 for a similar quantity.
2. Request a larger quantity from your physician
Purchasing medications in larger quantities often reduces the cost per pill, and this principle applies to ED medications as well. By opting to buy ten pills at one time rather than one at a time, you can greatly decrease the overall price per pill. Even when your insurance or Medicare Part D covers the medication, larger prescriptions may still lead to savings. With fewer refills, you may end up paying fewer copays over time.
If you're interested in this approach, consider discussing it with your healthcare provider to adjust your current prescription accordingly.
3. Ask for a generic option
Generic alternatives to Viagra, Cialis, and Levitra tend to be less expensive and more likely to receive coverage from insurance plans. Take sildenafil, for example; this generic form of Viagra costs around $1,394 for a 30-pill supply (100 mg each), while the brand name might range up to $2,867 for the same quantity. This price difference is significant, and both are essentially the same medication. The same cost-saving principle applies to tadalafil (generic Cialis) and vardenafil (generic Levitra).
4. Explore other brands
It’s worthwhile to investigate that some ED medications may offer a more favorable price point than others. In certain cases, switching to alternatives like Cialis or Levitra could prove to be more cost-effective than Viagra. As always, consult with your healthcare provider before making any changes to your medication regimen.
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5. Address underlying health issues
Since erectile dysfunction can often be a symptom of other medical problems, such as hypertension or diabetes, it’s important to approach treatment holistically. Insurance plans, including Medicare and Medicaid, are much more likely to cover medications addressing these underlying conditions over ED itself.
RELATED: What causes erectile dysfunction?
Additionally, certain medications may inadvertently cause erectile dysfunction, so it’s beneficial to have your healthcare provider review your medication list for any potential culprits. Furthermore, lifestyle changes such as quitting smoking, managing stress, maintaining a healthy diet, and exercising regularly can also significantly improve or even treat ED symptoms. If your insurance does not cover ED medications, exploring these alternative approaches may be worthwhile.