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Is Viagra covered by insurance?
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Is Viagra covered by insurance?

Sexual health is an integral part of everyday life, but not exactly a comfortable topic for dinner party conversations. Bringing up your erectile dysfunction at Thanksgiving isn’t necessarily going to prompt a lively discussion on men’s health. But it’s important to address ED, as it can have a significant impact on a man’s life, affecting his body, mind, and emotions. Fortunately, your doctor is always open to talking about your sex life and prescribing drugs like Viagra to help.

Viagra (What is Viagra?) is a popular prescription drug that treats erectile dysfunction. It has helped men of all ages improve their sex life, and therefore, quality of life, for more than 20 years. And while ED is a common condition—studies predict there will be 322 million cases worldwide by 2025—Pfizer’s “little blue pill” isn’t exactly cheap, at an average of $61.54 per pill. 

The good news is that whether or not your health insurance provider covers Viagra, a healthy sex life doesn’t need to break the bank. There are several ways to make erectile dysfunction treatment much more affordable. If you’re curious about Viagra insurance coverage, you’ll find everything you need in this article, along with a few helpful money-saving tips. 

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Is Viagra covered by insurance?

First things first, you should check with your insurance company to see whether they cover Viagra or other ED drugs. If they do, problem solved. But even if they don’t, your specific insurance plan might provide coverage for comparable medications, like generic versions. So, which drugs might be covered?

  • Viagra (sildenafil): We’ll start with the most common ED drug. Viagra insurance coverage is hit or miss, especially since the FDA approved the sale of generic sildenafil. Insurance companies are more likely to cover the latter because it’s half the price of brand-name Viagra. The same goes for Revatio, another name brand of sildenafil. However, the use of Revatio may affect insurance coverage since it primarily treats pulmonary arterial hypertension (it’s used off label for ED). The most common side effects for all versions of sildenafil are headache, flushing, and upset stomach.
  • Cialis (tadalafil): Cialis is in the same boat as Viagra. Companies are hesitant to provide insurance coverage for the brand-name drug but are more likely to cover the less-expensive generic version. However, Cialis is also occasionally used as a treatment for benign prostatic hyperplasia (BPH), commonly known as enlarged prostate. When prescribed for BPH, it’s more likely that insurance will cover Cialis. Either way, you may experience headaches, upset stomach, or muscle pain as side effects.
  • Levitra (vardenafil): Once again, many healthcare plans shy away from covering the expensive brand-name Levitra, but may cover generic vardenafil. Its most common side effects include headache, congestion, and dizziness. 
  • Stendra (avanafil): A lesser-known brand of ED medication is Stendra. It does not have a generic version, but the cost could be comparable to other ED pills. Ask a pharmacist how it stacks up to other brands. Stendra side effects include headaches, flushing, and dizziness.
  • Generic versions: The brand names above are often double the cost of their generic counterparts. Consequently, insurance companies are more inclined to provide coverage for generic sildenafil, tadalafil, or vardenafil. The best part? Generic ED meds are chemically the same as brand versions, so you’ll receive the same benefits for a fraction of the cost. If you’re discouraged by the cost of brand-name medications, ask your doctor if one of these generic drugs might be a good fit for you.

If your health plan covers any of these name brand or generic drugs, you most likely will still have a copayment, but the amount depends on your specific plan. When you discuss coverage with your insurance provider, be sure to ask how much your copay will cost. 

Consult your primary care physician or urologist when evaluating ED drugs, as the best drug for you largely depends on your health history, lifestyle, and other current medications.

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Should insurance cover erectile dysfunction drugs?

There have been plenty of recent discussions on whether insurance should cover medications like ED drugs and birth control. But as researchers have studied them more extensively, they’ve discovered that these medications have health benefits beyond sexual activity, giving insurance companies more reason to provide coverage.

When most people think of ED drugs, they think of medications that enable healthy sexual activity. Although better sex is their primary function, medicines like Viagra have a broader scope of men’s health benefits, most significantly concerning the heart. Viagra’s active ingredient, sildenafil citrate, works by blocking PDE5, an enzyme that prevents smooth muscle relaxation. One study indicated that the daily use of sildenafil can prevent heart muscle thickening, reducing the risk of early-stage heart failure. It’s also proved effective in treating pulmonary arterial hypertension, a condition that’s characterized by high blood pressure in the arteries that enter the lungs.

Sexual dysfunction can also be mentally and emotionally distressing, damaging to a man’s confidence and self-esteem. “Not being able to perform in the bedroom can be one of the most hurtful feelings a man can have,” says Michael Hall, MD, the founder of the Hall Longevity Clinic. “Regardless of who he’s with, whether it’s his spouse of 50 years or someone he just met, erectile dysfunction can create great psychological angst and even lead some men to suicide.” 

So, by revitalizing his sex life, erectile dysfunction drugs simultaneously restore a man’s mental and emotional health. In a Journal of General Internal Medicine study, men who received sildenafil “reported significantly greater improvements in self-esteem, confidence, sexual relationship satisfaction” over men who received a placebo.

“Erectile dysfunction is highly under-diagnosed and a scary concept for any man, so Viagra, Levitra, and Cialis can have a significant impact on the way a man lives his life,” Dr. Hall says.

Does Medicare cover Viagra?

The short answer is no. Most Medicare Part D plans don’t currently cover Viagra. But that doesn’t mean you’re out of luck. Some Part D plans will offer coverage for generic Viagra (sildenafil) and similar medications. Cialis may be covered when prescribed for BPH or insurance may cover Revatio, which is indicated for use in pulmonary arterial hypertension.

Part D is an optional plan for Medicare beneficiaries that provides prescription drug coverage. Each plan has a formulary (a list of covered drugs) that you should review before choosing a plan. Use the Medicare Plan Finder to look for a plan that includes sildenafil or similar medications. Premiums vary depending on the plan you select, and you can choose to have them deducted from your Social Security check each month, or you can pay them separately. However, some plans might not require a premium at all.

What about Medicaid?

Another government-funded policy, Medicaid often does not cover Viagra or other ED drugs, as they’re usually prescribed for lifestyle issues and not deemed “medically necessary.” If prescribed for health problems other than erectile dysfunction, however, they may be covered. 

Medicaid policies can vary from state to state, so you should check with your specific state’s program before writing this option off. 

How to save on Viagra

So far, we’ve determined that if you need Viagra, you can’t always count on assistance from your insurance provider or Medicare plan. And brand-name Viagra can be prohibitively expensive. However, even if your insurance doesn’t provide coverage, there are still ways to get erectile dysfunction drugs at a discount. You just need to know a few tricks. 

1. Ask your doctor for a larger quantity 

There’s a reason that companies like Costco can offer such great deals. Buying in bulk almost always lowers the cost per unit, and this applies to drug costs, too. Purchasing 10 pills at once will likely yield a lower price per pill than buying one at a time. Even if insurance or Medicare Part D does cover your medications, bigger (larger quantity) prescriptions can still save you money. Each time you fill a script, you owe a copay. Your deductible and prescribed dosage determines your copay. If you don’t need to refill quite as often, you’ll end up having fewer copays. Consult your doctor about changing your current prescription. 

2. Ask your pharmacist for a generic version or cheaper brand

Generic drugs are more likely to be covered by insurance, and they’re also a lot cheaper. Take sildenafil (generic Viagra), for example. It costs $116 for 10, 100 mg tablets on singlecare.com, while the name-brand equivalent costs $450. That’s a massive difference. And it’s the exact same medication. The same goes for tadalafil (generic Cialis) and vardenafil (generic Levitra). 

If you’d rather stick with the name brands, you might find that some are more affordable than others. In some instances, Cialis, Levitra, and other alternative ED drugs might be more cost-effective than Viagra. You’ll want to check with your doctor, of course, before diving into any new medication.

3. Use SingleCare

SingleCare is all about making prescriptions more affordable. Whether or not your insurance covers your ED medication, you can use SingleCare coupons for a discount. Sometimes, SingleCare’s lowest price is even lower than your insurance copay would be. It’s completely free to use.

Viagra and other ED drugs can be vital to a healthy sex life and your overall well-being. And the FDA-approval of generic versions has made these medications increasingly accessible. Navigating insurance and Medicare coverage is tricky, but you can rest assured. There are still plenty of ways to save money on Viagra.