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Does Health Insurance Cover ED Meds?

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Erectile dysfunction (ED) is a sexual health problem characterized by the inability to obtain or keep an erection for satisfactory sexual activity. ED (impotence) is a common medical condition that affects around 30 million men in the United States. Viagra is a prescription drug that is commonly used to treat erectile dysfunction. Other erectile dysfunction drugs that are FDA-approved are Cialis and Levitra

Since it was approved by the Food and Drug Administration in 1998, Viagra, commonly called the “little blue pill,” has improved the sex lives of millions of men affected by ED. But Viagra and other ED drugs are not exactly cheap. The cash price for brand name Viagra is over $61 per pill, which is prohibitively expensive for many people. 

Continue reading to learn more about prescription drug coverage, including Medicare coverage, for Viagra. Also, find out whether an insurance provider will cover Cialis and other oral medications used to treat ED and sexual dysfunction.

Do erectile dysfunction medications come under prescription drug coverage?

You will need to check with your insurance company to see whether Viagra and other ED drugs are covered by your insurance plan. Some insurance companies cover the generic versions of certain medications, which are significantly cheaper than their brand name equivalents. 

Your specific insurance plan may provide coverage for generic Viagra (sildenafil citrate) but not the brand name version. It could also be that your insurance plan does not cover Viagra but covers other comparable ED drugs. It may be that only a certain number of pills are covered by insurance every month. 

Is generic Viagra the same as brand name Viagra?

Both the generic and brand name drug contains the same active ingredient, sildenafil. They are chemically the same and are equally effective and safe. However, brand name medications are often double the cost of their generic counterparts. Therefore, insurance companies are more inclined to provide coverage for generic Viagra. The same is true for other ED drugs like Cialis and Levitra

Is Viagra covered by health insurance plans?

Viagra is the most commonly prescribed medication to treat sexual dysfunction (erectile dysfunction). Insurance coverage for brand name Viagra is unreliable. Insurance companies are more likely to cover the generic form of Viagra (sildenafil citrate) because it costs about half the brand name version. 

Notably, the use of another medication, Revatio, may affect insurance coverage. Revatio contains the same active ingredient as Viagra, sildenafil. However, Revatio is primarily used for the treatment of pulmonary arterial hypertension. The use of Revatio for erectile dysfunction is off-label and may not be covered by insurance.

Is Cialis usually covered by insurance?

Besides Viagra, Cialis (tadalafil) and Levitra (vardenafil) are other commonly prescribed erectile dysfunction drugs. Insurance coverage for these two medications is similarly a hit or miss. An insurance company is more likely to cover the less expensive generic drugs than the brand name medications. Notably, Cialis is also used to treat benign prostatic hyperplasia (BPH). When it is prescribed for this medical condition, insurance is more likely to cover Cialis.

How much does Viagra cost per pill with insurance?

Ideally, you want to take an ED medication that works for you and causes minimal side effects. But price and insurance coverage are often deciding factors in choosing an erectile dysfunction drug. This is because medications like Viagra can be prohibitively expensive without insurance. 

Your insurance plan may cover either the brand name or generic version of Viagra. However, there may be restrictions on the number of pills you can receive every month. After reaching this limit, your out-of-pocket cost for one tablet of Viagra can range anywhere from $20 to $50. The average price of Viagra is $15-$20 per tablet. However, drug costs will vary depending on your plan type and copay. As noted, the cash price of generic drugs is usually cheaper than branded ones.

Always call your insurance provider and verify which erectile dysfunction drugs are covered by your plan. Many insurance plans require prior authorization (your doctor will need to take permission from the insurance company before starting treatment). Your insurance company will also tell you how many refills you can get, which dosages are covered, and whether there are any other restrictions.

Does Medicare cover Viagra?

Medicare Part D plans do not cover the brand name drug Viagra. However, sildenafil, which is the generic form, is covered by Medicare Part D. Some Medicare Advantage plans (MAPD plans) have brand name Viagra covered as well as the generic version. You will need to look at your plan’s drug formulary (list of covered drugs) to check Medicare coverage. The same is true for Cialis (tadalafil) and Levitra (vardenafil). The generic versions are more likely to be covered by your Medicare plan. The drug class for these erectile dysfunction drugs is PDE5 inhibitors.

Obtain professional medical advice for ED treatment

While cost is certainly an important factor in deciding between the various ED drugs, it is important to get professional medical advice from a doctor before starting treatment with these prescription drugs. These medications may not be right for everyone. Your doctor may want to treat other conditions, such as high blood pressure, that can affect blood flow to the penis. A healthcare provider can also advise you about using the branded or generic version of an ED medication. The good news is that whether or not your insurance plan provides coverage for Viagra and other ED medications, your sexual health does not have to suffer. BuzzRx coupons can help you save money and enjoy a healthy sex life without breaking the bank.
 

References

  1. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts#: