Is Viagra Covered by Insurance?

Viagra, a leading prescription medication to address erectile dysfunction (ED), has assisted men in enhancing their sexual health for over two decades. Despite the prevalence of ED, with predictions estimating 322 million cases globally by 2025, the cost of Pfizer's “little blue pill” remains a concern, averaging over $100 per pill.

While insurance coverage for Viagra, Medicare, and Medicaid is often lacking, there are various ways to make treatment for erectile dysfunction more budget-friendly.

Typically, commercial health insurance plans do not include brand-name ED medications like Viagra, Cialis, Levitra, and Stendra. However, insurance is more likely to cover generic versions such as sildenafil, tadalafil, and vardenafil. Even if included in a plan's formulary, coverage may come with restrictions like prior authorization or limited quantities.

If your health insurance does cover these medications, it’s probable you will still face a copayment, which varies based on your specific plan. Be sure to inquire about copay amounts when discussing coverage with your insurer.

Engaging with a healthcare professional, such as your primary care doctor or urologist, is crucial when assessing ED medications, as the choice largely depends on your individual health history, lifestyle factors, and any other medications you may be taking.

Does Medicare cover Viagra?

The majority of Medicare prescription plans do not cover brand-name Viagra. Some Medicare drug plans may include generic ED medications, but only if deemed medically necessary and prescribed for conditions beyond erectile dysfunction. For instance, generic Cialis (tadalafil) might be covered when prescribed for BPH, or Medicare may approve Revatio (sildenafil), indicated for pulmonary arterial hypertension.

Each Medicare plan includes a formulary (a list of covered medications) that you should review when selecting a plan. Use the Medicare Plan Finder to search for options that encompass ED medications.

Additionally, Medicare Part B may cover certain ED-related services, such as evaluations, diagnostic tests, and devices for penile implants.

Does Medicaid cover Viagra?

Similar to Medicare, Medicaid generally does not cover Viagra or similar ED medications, as they are typically regarded as lifestyle treatments rather than medically necessary. However, if prescribed for other health issues, generic forms of these drugs may be covered.

Since Medicaid policies can differ widely by state, it’s advisable to check with your specific state’s program for coverage details.

How to save on Viagra

Having established that insurance assistance for Viagra is often limited, and given the high cost of brand-name Viagra, there are still approaches you can take to obtain erectile dysfunction medications at reasonable prices. Knowledge of a few cost-saving strategies can be immensely beneficial.

1. Utilize Prescription Discount Programs

Programs like SingleCare are dedicated to making prescriptions more affordable. Whether or not you have insurance, SingleCare can help you find the best prices at your local pharmacies and offer coupons to further lower costs. It’s free to use; for example, generic Viagra costs around $11.51 for 30 pills at 100 mg through SingleCare, while generic Cialis is priced at approximately $15 for 30 pills at 20 mg.

2. Request a larger quantity

Buying a larger quantity often reduces the price per unit, which applies to medications as well. Ordering 10 pills at once typically costs less per pill compared to purchasing them individually. Even if your medications are covered by insurance or Medicare Part D, larger prescriptions can minimize overall expenses. Since each refill incurs a copay based on your deductible, reducing refills can result in fewer copays over time.

Discuss this option with your healthcare provider to modify your prescription accordingly.

3. Inquire about Generic Alternatives

Generic versions of medications such as Viagra, Cialis, and Levitra are not only more likely to be included in insurance plans but are also significantly cheaper. For instance, sildenafil as a generic form of Viagra averages $1,394 for 30 pills at 100 mg, in contrast to the brand-name version costing around $2,867 for the same quantity. This price difference is substantial, particularly since both versions contain the same active ingredient. The same principle applies to tadalafil (generic Cialis) and vardenafil (generic Levitra).

4. Explore Alternative Brands

Certain erectile dysfunction medications may be more affordable than others. At times, alternatives such as Cialis or Levitra might provide cost benefits compared to Viagra. It's essential to consult your healthcare provider before making any changes to your medication regimen.

5. Address Underlying Health Issues

Erectile dysfunction can be symptomatic of other health conditions, such as high blood pressure or diabetes. Coverage for these underlying conditions is typically more available through insurance, Medicare, and Medicaid compared to ED medications. 

Additionally, certain medications might contribute to ED as a side effect; thus, consulting your healthcare provider to evaluate your medication list is wise.

Lastly, consider non-pharmaceutical options to combat ED, such as lifestyle changes including quitting smoking, managing stress effectively, increasing physical activity, and developing healthy dietary habits. If your insurance doesn’t cover ED medications, exploring alternative treatments might be a viable path.