Is Viagra Covered by Insurance?
Key Takeaways
Viagra, a popular drug for erectile dysfunction, often has variable insurance coverage, with generic versions more likely to be covered.
Erectile dysfunction medications, including Viagra, can offer health benefits beyond improving sexual activity, potentially impacting men’s mental, emotional, and cardiovascular health.
Medicare Part D typically does not cover Viagra, but some plans may cover generic versions or similar medications prescribed for conditions like pulmonary arterial hypertension.
There are strategies to reduce the costs of erectile dysfunction drugs, such as bulk purchasing, opting for generic versions, or utilizing prescription discount services like SingleCare.
Viagra is a well-known prescription medication used to treat erectile dysfunction (ED) that has helped millions of men enhance their sexual health since its introduction over 20 years ago. While ED is a common condition affecting a significant portion of the male population—predictions indicate 322 million cases globally by 2025—the costs associated with Viagra can be staggering, often averaging more than $100 per pill.
Despite the commonality of ED and the availability of Viagra, many individuals face challenges when seeking insurance coverage for this treatment. Typically, insurance providers, Medicare, or Medicaid do not cover Viagra and various other ED medications. However, there are numerous strategies to make the treatment more cost-effective for patients.
In general, commercial health insurance plans do not cover brand-name ED drugs such as Viagra, Cialis, Levitra, and Stendra. Insurance policies are more inclined to approve coverage for generic alternatives to these medications—namely sildenafil, tadalafil, and vardenafil. Even when these options are included in the formulary of your plan, you may encounter restrictions regarding their coverage, such as prior authorizations or quantity limits.
If your health plan does cover these medications, you will likely still have a copayment, with the cost contingent upon your specific plan’s terms. It’s advisable to discuss copayment amounts with your insurance provider to understand your out-of-pocket expenses.
Your primary care physician or urologist should be consulted when considering ED medications, as the optimal choice often hinges on your health history, lifestyle choices, and any concurrent medications.
Does Medicare Cover Viagra?
Most Medicare prescription plans currently do not include coverage for the brand-name Viagra. Some Medicare drug plans may cover generic ED medications, but typically only when they are deemed medically necessary for other health conditions beyond erectile dysfunction. For instance, generic Cialis (tadalafil) may be covered if prescribed for BPH (Benign Prostatic Hyperplasia), while Medicare might approve Revatio (sildenafil) for treatment related to pulmonary arterial hypertension.
It’s important to review the formulary associated with your Medicare plan before finalizing your coverage choice. Utilize the Medicare Plan Finder to identify a plan that includes ED medications.
Note: Medicare Part B may encompass other ED-related services, including examinations, diagnostic tests, penile implant surgeries, and Coloplast devices.
Does Medicaid Cover Viagra?
Medicaid also typically does not provide coverage for Viagra or similar ED medications, as these are generally classified as lifestyle issues rather than necessary medical treatments. However, if prescribed for medical conditions other than erectile dysfunction, generic versions of these medications may qualify for coverage.
It’s significant to note that Medicaid policies vary from one state to another, so checking with your specific state’s Medicaid program is a critical step before dismissing this coverage option outright.
How to Save on Viagra
As we have established, if you require Viagra, you can’t always depend on your insurance provider or Medicare plan for financial assistance. The price for brand-name Viagra can be prohibitively high. Nevertheless, even if your insurance doesn’t offer coverage, numerous methods can help you obtain erectile dysfunction medications at more affordable prices.
1. Utilize SingleCare
SingleCare is dedicated to making prescriptions more affordable. Regardless of whether or not you have insurance, SingleCare can help find lower prices at local pharmacies and provide coupons for further discounts. This service is entirely free. For instance, using SingleCare, generic Viagra costs approximately $11.51 for 30 tablets of 100 mg, while generic Cialis is around $15 for 30 tablets of 20 mg.
2. Request a Larger Quantity
Buying in bulk can often lead to lower unit costs, and this principle applies to medications as well. Purchasing a larger quantity, such as 10 pills at once, usually results in a reduced price per pill compared to buying them individually. Even if your insurance or Medicare Part D covers your medications, receiving a larger quantity can ultimately save you money. Every fill entails a copayment based on your deductible and the number of pills, so less frequent refills mean fewer copays.
If you find this approach appealing, consult your healthcare provider regarding modifying your current prescription.
3. Inquire About Generic Alternatives
Generic versions of Viagra, Cialis, and Levitra are not only more likely to receive insurance coverage, but they also tend to be significantly cheaper.
For example, sildenafil, the generic version of Viagra, averages around $1,394 for 30 tablets of 100 mg, while its brand-name counterpart can cost approximately $2,867 for the same quantity. This discrepancy highlights the substantial cost difference between the two. The same is true for tadalafil (generic Cialis) and vardenafil (generic Levitra).
4. Consider Switching to a Different Brand
Some ED drugs are more economically viable than others. In certain instances, Cialis, Levitra, and other alternative ED medications might be more affordable compared to Viagra. Always consult with your healthcare provider before making any transitions to new medication.
RELATED: Alternatives to Sildenafil and How to Switch Your Prescription
5. Address Underlying Health Issues
Erectile dysfunction can often be symptomatic of other health issues, such as high blood pressure or diabetes. Insurance, Medicare, and Medicaid are generally more likely to cover medications that treat these health conditions rather than those specifically for ED.
RELATED: Common Causes of Erectile Dysfunction
Furthermore, ED can sometimes be a side effect of certain medications. It’s prudent to review your current medication list with your healthcare provider to identify any potential culprits.
Additionally, exploring natural remedies such as adopting healthy lifestyle changes—including smoking cessation, stress management techniques, regular exercise, and a balanced diet—can also improve or mitigate ED symptoms. If your health insurance plan does not cover ED medications, these alternatives could be worthwhile to consider.