Is Viagra Covered by Insurance?

Viagra is a well-known prescription medication that has been helping men combat erectile dysfunction (ED) for over two decades. Despite the widespread prevalence of ED—with studies expecting 322 million cases worldwide by 2025—the costs associated with obtaining Viagra can be quite high, averaging $100 or more per pill.

While insurance plans, including Medicare and Medicaid, typically do not cover Viagra or many other ED medications, there are still numerous avenues available to help alleviate the expense of ED treatments.

Most commercial health insurance policies do not offer coverage for brand-name ED medications such as Viagra, Cialis, Levitra, and Stendra. However, insurance is more inclined to cover the generic equivalents of these drugs (sildenafil, tadalafil, vardenafil). Even if these medications are included in your plan's formulary, coverage may come with certain restrictions, including prior authorization or limits on the quantity that can be prescribed.

Should your health plan provide coverage for any of these ED medications, you may still be subject to a copayment, the amount of which varies based on your insurance plan. When discussing potential coverage with your insurance provider, be sure to inquire about the copayment amounts associated with your prescription.

It's essential to consult your primary care physician or a urologist when determining the best ED medication for you, as considerations like health history, lifestyle, and any concurrent medications will greatly influence the decision.

Does Medicare cover Viagra?

Currently, most Medicare prescription plans do not extend coverage to brand-name Viagra. Certain Medicare drug plans might cover generic ED medications, but only if they are deemed medically necessary and prescribed for conditions apart from erectile dysfunction. For instance, generic Cialis (tadalafil) might be covered when prescribed for BPH, while Medicare may approve Revatio (sildenafil), which is utilized for pulmonary arterial hypertension.

Each Medicare plan comes with a specific formulary (a list of covered medications) that should be reviewed before selecting a plan. You can utilize the Medicare Plan Finder to help identify a plan that includes coverage for ED medications.

It’s important to note that while Medicare Part B might not cover Viagra, it can provide coverage for other ED-related services, which may include exams, diagnostic testing, penile implants, and coloplast devices.

Does Medicaid cover Viagra?

Similar to Medicare, Medicaid often does not pay for Viagra or other ED drugs, as these medications are typically seen as lifestyle treatments rather than medically necessary interventions. However, if they are prescribed for health issues other than erectile dysfunction, generic versions may be eligible for coverage.

Medicaid regulations differ by state, so it is advisable to consult with your specific state's program to ascertain what coverage options are available.

How to Save on Viagra

As we've established, if you require Viagra, relying solely on insurance assistance or Medicare might not be sufficient. Given the high cost of brand-name Viagra, here are some helpful strategies to secure more affordable erectile dysfunction medications.

1. Utilize SingleCare

SingleCare focuses on making prescriptions more accessible and affordable. Regardless of your insurance status, SingleCare can help you find the lowest prices at local pharmacies and allow you to use discounts to reduce costs further. This service is free. For instance, through SingleCare, generic Viagra is priced at approximately $11.51 for 30, 100 mg tablets, and generic Cialis is around $15 for 30, 20 mg tablets.

2. Request a larger quantity from your doctor

Buying in larger quantities often reduces the cost per unit, which is also applicable to prescription drugs. Purchasing a supply of 10 pills in one transaction is usually cheaper per pill compared to purchasing them individually. If your insurance or Medicare Part D covers your medications, a larger prescription can save you money by decreasing the frequency of your copayments.

If this approach resonates with you, discuss the possibility of modifying your current prescription with your healthcare provider.

3. Opt for generic versions

Generic alternatives to Viagra, Cialis, or Levitra not only have a higher likelihood of being covered by insurance, but they are also significantly less expensive. For example, while generic sildenafil costs around $1,394 for 30, 100 mg tablets, the brand-name equivalent is about $2,867 for the same quantity. This stark cost difference reflects that they contain identical active ingredients.

4. Explore more affordable brands

You may find that certain ED medications are priced lower than others. In some instances, Cialis, Levitra, and various other alternative ED treatments might be more budget-friendly compared to Viagra. Always consult with your healthcare provider before switching to a new medication.

RELATED: Examine Levitra alternatives and the process of updating your prescription

5. Address underlying health conditions

Erectile dysfunction is sometimes symptomatic of additional medical issues like high blood pressure or diabetes. Insurance plans, Medicare, and Medicaid are far more likely to cover medications for these conditions over ED drugs.

RELATED: Investigate the causes of erectile dysfunction

ED can also result from side effects associated with certain medications, so it’s wise to have your healthcare provider review your current medications to identify any possible culprits.

Additionally, ED might be improved or treated through lifestyle changes such as quitting smoking, managing stress, exercising regularly, and maintaining a healthy diet. If your health insurance plan does not cover ED medications, consider exploring these alternative avenues for addressing erectile dysfunction.