Search for articles or Rx savings
Key takeaways
Common erectile dysfunction medications include Cialis (tadalafil), Viagra (sildenafil), vardenafil, and Stendra(avanafil). Overall, insurance companies list ED medications as “lifestyle medications” and won’t cover them unless you can show a medical condition causes your ED.
Some Blue Cross Blue Shield insurance programs will cover these medications, but they are often only covered if you can document medical necessity. Step authorization and prior authorization are also usually required.
Even if Blue Cross Blue Shield covers your ED medication, you may have out-of-pocket costs like deductibles and co-payments.
Erectile dysfunction (ED), sometimes referred to as impotence, is a condition where you have difficulty becoming erect and maintaining erections. ED is more common than many people might realize, impacting about 24% of men in the U.S., including over 50% of men over the age of 75. The causes of ED are usually multifactorial and can include psychological triggers, medication side effects, and underlying medical conditions. Treatment of erectile dysfunction most commonly involves a class of drugs known as phosphodiesterase type 5 inhibitors (PDE-5 inhibitors or PDE5i). This includes FDA-approved medications like Viagra (sildenafil), Cialis (tadalafil), vardenafil, and Stendra(avanafil).
Health insurance coverage for erectile dysfunction differs from one health insurance company to another. Often, an insurance company is more likely to cover ED treatment if you can document that a medical condition like diabetes mellitus or heart disease causes your ED.
If you have Blue Cross Blue Shield (BCBS) health insurance, you might be wondering: Does Blue Cross Blue Shield cover erectile dysfunction? Read on to learn more about how this insurance company covers ED treatment, eligibility and exclusions, and how to navigate the ins and outs of coverage.
Does Blue Cross Blue Shield cover erectile dysfunction (ED) treatment?
Blue Cross Blue Shield (BCBS) may cover erectile dysfunction treatment in some instances. But it varies widely from one health plan to another. It’s important to keep in mind that BCBS isn’t just one health insurance company. Instead, the Blue Cross Blue Shield Association (BCBSA) is made up of 33 independent, locally operated, and community-based companies associated with BCBS. That’s part of why it can be difficult to generalize about what medication the company does or does not cover.
As Jason B. Carter, MD, urologist and medical advisor at Aeroflow Urology, points out, “Blue Cross Blue Shield plans vary widely by state.” According to Dr. Carter, BCBS plans often don’t cover the brand names of common PDE5 inhibitors, such as Viagra or Cialis. “They may cover a limited quantity of generic sildenafil or tadalafil, often 6-10 tablets per month, with a tier-3 or tier-4 copay,” Dr. Carter explains.
Here’s what else to know about BCBS erectile dysfunction coverage.
Medical necessity
Many commercial health insurance plans list ED drugs as lifestyle medications, which means they are excluded from standard coverage, according to Dr. Carter. But there are exceptions. “If a patient’s ED is due to a medical condition such as diabetes, hypertension, prostate cancer, or spinal cord injury, some insurers will cover part or all of the cost of treatment as long as medical necessity is clearly documented,” he explains.
If a medical condition causes your ED, it can be helpful if your healthcare provider documents this for the insurance company. “Medical necessity is established through a detailed note including ICD-10 diagnosis and documentation of contributing diseases and prior failed treatments,” Dr. Carter explains.
Prior authorization
BCBS plans often require prior authorization for a drug to cover it. Prior authorization is when you get advanced approval from an insurance company for a particular medication. “Prior authorization is rarely required for generic sildenafil or tadalafil, but it may be required for branded Viagra or Cialis,” Dr. Carter shares.
Step therapy
Step therapy—where your insurance company requires you to try another similar, but cheaper medication before your desired medication is covered—is often necessary for ED medications. “Some insurers impose step therapy requiring a patient to try a generic PDE5 inhibitor before trying a branded one,” Dr. Carter explains. However, each health insurance company differs in terms of the medications you are required to try.
Mail-order pharmacies
Sometimes, BCBS plans require you to use a local or mail-order pharmacy for discounted pricing. “If a patient exceeds the covered quantity of tablets, additional tablets are considered an out-of-pocket expense,” Dr. Carter explains. “In those cases, I often encourage patients to price compare among different pharmacies, including ones that compound medications, which can provide significant savings.”
How much does erectile dysfunction treatment cost?
The cost of erectile dysfunction treatment varies based on which medication you are using. Without insurance, these medications can be costly, though it often depends on whether you’re using the brand-name or generic version of the medicines.
Here’s how much the most common ED treatments cost without insurance:
- Viagra (brand name): $1,063.24 for 10, 100mg tablets
- Sildenafil (generic Viagra): $1,369.94 for 30, 100mg tablets
- Cialis (brand name): $440.27 for 30, 5mg tablets
- Tadalafil (generic Cialis): $986 for 90, 5mg tablets
- Vardenafil: $472.85 for 10, 20mg tablets
- Stendra: $500.70 for 6, 200mg tablets
- Avanafil (generic Stendra): $577 for 6, 200 mg tablets
SingleCare savings
Save up to 80% on Viagra with SingleCare
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
If your insurance isn’t covering your ED treatment, SingleCare can help. With a SingleCare savings card, your out-of-pocket expenses for common ED drugs can be greatly reduced. Here’s how much popular ED drugs typically cost with a SingleCare savings card:
- Viagra (brand name): $13.48 for 30, 100mg tablets
- Sildenafil (generic Viagra): $13.48 for 30, 100mg tablets
- Cialis (brand name): $17.06 for 90, 5mg tablets
- Tadalafil (generic Cialis): $17.06 for 90, 5mg tablets
- Vardenafil: $37.65 for 10, 20mg tablets
- Stendra: $138.79 per 6 200mg tablets
How much does erectile dysfunction treatment cost with BCBS?
In cases where your health insurance covers BCBS, the medication will either be covered completely or partially, and you will also owe a copayment. According to Dr. Carter, average copayments for ED medications can range from $10 to $60, depending on deductible status.
Even if your health insurance companies cover the cost of your ED medication, you may have to meet your deductible first to receive coverage. You may also have coinsurance costs. Finally, you may be required to pay a copayment for these medications.
How to check whether your BCBS plan covers erectile dysfunction treatment
There are two primary ways to determine if your BCBS plan covers ED treatment.
Check your BCBS account online
First, you can log in to your account online. From there, you should be able to access a list of covered medications, as well as medications that require prior authorization or step therapy. It can also be helpful to access your insurance plan’s formulary, a list of covered medicines that your specific plan covers.
Call your BCBS health plan
You can also call your insurance company. Their number can usually be found on the back of your health insurance card or on the company’s website. A health insurance customer service agent may be able to find out more detailed information about medication insurance coverage than can be found online. You can also ask questions about any requirements that must be met for your ED drug to be covered.
How to save on erectile dysfunction treatment
Sometimes it can be challenging to get your health insurance company to cover your erectile dysfunction medications. But there are ways to save on your medications. Here are some options:
SingleCare discount cards
SingleCare discount cards can help you save on your ED medications. The way they work is simple. Visit the SingleCare website and search for the medication you are interested in using. From there, you can print, text, or email the savings card. Alternatively, you can access the card via the SingleCare app.
Then, when you visit the pharmacy to pick up your prescription, you present your SingleCare discount card, and the pharmacist applies the discount to your order. There are no strings attached, and the savings cards are free to use. You can save up to 80% on your prescription drugs with a SingleCare discount card.
Manufacturer’s coupons
Often, drug manufacturers have coupons for specific drugs to help you save. The best way to learn more about this is to visit the website of a particular ED medication you are interested in taking or that has been prescribed to you. This information should be accessible on the website or found by searching for the medication plus the phrase “savings card.”
Look into alternative medications
If you are finding that your insurance company isn’t willing to cover a specific ED drug, you can ask your healthcare provider about a similar alternative medication to try. You can also consider generic versions of name brands like Viagra and Cialis. “Generics like sildenafil or tadalafil are widely available and often cost under $1 per tablet with discount cards or coupons,” Dr. Carter says.
Consider alternative ED treatments
Depending on your overall health and any underlying health conditions you may have, you may opt for an alternative ED treatment. “Consider using a penile constriction ring, vacuum erection device, or intracavernosal injections—all of which may be covered when pills are not,” says Dr. Carter. According to Dr. Carter, these alternative treatments are especially useful for people who are diabetic or who are experiencing post-prostatectomy ED, which is erectile dysfunction that occurs after prostate surgery.
Connecting with a physician who is experienced in sexual dysfunction, men’s health, or sexual medicine can help you learn more about alternative medications and treatment options for ED.
- Symptoms & causes of erectile dysfunction, National Institute of Diabetes and Digestive and Kidney Diseases at the NIH (2024)
- The Blue Cross and Blue Shield system, Blue Cross Blue Shield Association (2025)
- Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician, J Med Life (2017)