Does Insurance Cover Viagra?
If there’s at least one thing on this planet that we can all agree on, it’s that we all want good sex. Unfortunately, for 30 million men in the United States alone, erectile dysfunction (ED) stands in the way of that. And that’s like, not cool, man.
Erectile dysfunction can affect men of any age, but it’s more common in middle-aged and older men — and as you get older, questions about the medications you’ll need to use come with more questions about costs.
Chances are, you’re here because you’re wondering how big of a budget cut you’ll need to make to keep your sex life cruising if (or when) you ever need a little help. Can you use insurance to make sure you’re covered?
Below, we’ve explained insurance coverage for Viagra® (one of the most popular ED medications on the market), how Medicaid and Medicare determine coverage for Viagra and what your out-of-pocket cost may look like if you qualify for coverage. Let’s start with the surprisingly complicated question of whether insurance covers Viagra (spoiler: the answer is maybe).
Is Viagra Covered by Insurance?
The brand-name drug Viagra is generally not covered by insurance plans. However, each plan differs in their coverage policies, so we can’t say no for sure without reading the fine print. You’ll need to check with your provider to verify your prescription drug coverage and to see whether Viagra is covered.
Most insurance plans don’t cover brand-name PDE5 inhibitors, a class of medications that treats ED and includes Viagra, Cialis® and Levitra®. These drugs inhibit the action of a specific enzyme that regulates blood flow to your penis, allowing you to get and maintain an erection. But nowadays most PDE5 inhibitors are available as generics, which means you may not need that brand name that’s not covered.
Viagra has been around since the late 90s, but now, many generic versions exist under the name sildenafil. Some insurers may cover sildenafil even when they don’t cover Viagra.
But that’s not necessarily a red flag one way or the other. Many insurance companies won’t automatically cover brand-name drugs if a generic is available.
If your plan doesn’t cover sildenafil either, you may be able to submit an appeal for coverage or obtain a prior authorization to get the prescription covered. Talk to your healthcare provider to learn more about your options.
How Much Is Viagra with Insurance?
As we noted, the chance that your insurance will cover Viagra is pretty low. But even if insurance does cover it (which could bring your cost down to zero after you meet your deductible and depending on your copayment), you won’t be getting quite the same deal as the guys who were buying Viagra when the first episode of Friends aired. That’s because the price of Viagra is much lower now.
One reason for this is the availability of generics. Viagra is an FDA-approved brand-name medication developed and marketed by Pfizer. At a certain point, other drug companies are able to make generics of brand-name drugs, which is why guys now also have sildenafil as an option. Sildenafil (or generic Viagra) is the active ingredient in Viagra and the name of the generic version.
Because they contain the same active ingredient, you can expect the same results from taking a 25mg to 100mg dose of Viagra as you would an identical dose of generic sildenafil.
It’s also worth noting that sildenafil will probably be your best-buy option regardless of your insurance coverage. According to the U.S. Food and Drug Administration (FDA), generic drugs cost up to 85 percent less than the same brand-name medication.
Viagra prices vary, and you should check out our blog for more information about the wide range of prices you might pay (and why). But for a quick snapshot of pricing, here’s what you need to know:
Viagra prices when the drug first debuted were much higher than they are today.
At peak, the price for a single pill without insurance coverage was more than $88 — imagine factoring that cost into date night.
Today, a generic version of the medication can cost as little as $1 to $4 per pill.
Prices are not standardized among manufacturers or retailers.
Rebates and other offers exist on a variety of websites, so if you see a price on a sticker, don’t assume it’s the lowest possible price.
Does Medicaid Cover Viagra?
For the most part, Medicaid doesn’t see Viagra as a medically necessary medication, which means it’s unlikely to cover Viagra for ED. But there’s some context in which a loophole might exist if you use sildenafil for other purposes.
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Does Medicare Cover Viagra?
Unfortunately, if you’re on Medicare coverage, your prescription drug coverage may be limited and probably won’t include Viagra.
Viagra and other prescription drugs for ED are considered voluntary (AKA not medically necessary), because sexual dysfunction isn’t life-threatening and you don’t have to have sexual activity for medical reasons. That means they aren’t covered under Original Medicare Parts A and B, and Viagra isn’t covered under Part C.
We’re not sure we agree with this — sexual dysfunction is hardly something to ignore, and while it may not kill you, studies show it can harm your self-esteem and confidence, and create both anxiety and depressive symptoms. It’s not-not a big deal.
You may have some prescription drug coverage under Medicare Part D, but a lot of this is going to depend on your plan, your provider, where you live and why you need the medication.
And a Medicare Part D plan can be an additional cost. In order to receive prescription drug coverage through Medicare, you need to purchase a stand-alone Medicare Part D Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug (MA-PD) plan. Both are available for purchase through private health insurance companies.
To determine whether Viagra is covered through Medicare Part D, you’ll need to check your drug formulary — a list of drugs the plan covers. Plan formularies can change at any time, so be sure to check for both Viagra and the generic sildenafil.
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Traditional Pill
SildenafilGeneric Viagra®
From £2.36/use
The most commonly prescribed ED treatment, contains the same active ingredient as Viagra® but is 80% more affordable than the brand name.
Traditional Pill
Daily TadalafilDaily Generic Cialis®
From £21/month
A clinically proven treatment for erectile dysfunction that helps men achieve and maintain erections more easily. It gives you the freedom to enjoy spontaneous sex without needing to plan ahead.
Traditional Pill
As-Needed TadalafilGeneric Cialis®
From £2.36/use
The unbranded, more affordable generic form of Cialis® taken as needed. It is clinically proven to help men get and keep harder erections for up to 36 hours.
Traditional Pill
Viagra Connect®
From £5.83/use
The over-the-counter branded version of sildenafil. Viagra Connect® improves blood flow to the penis, helping you achieve and maintain strong and satisfying erections.
Important safety information for Sildenafil, Tadalafil, Tadalafil Daily or Viagra Connect.
How to Get Viagra or Sildenafil Without Insurance
Viagra is only available by prescription, so you won’t be able to purchase it over-the-counter. That’s probably for the best, because using it against medical advice can be dangerous.
The best way to get Viagra is to speak to your primary care provider about a prescription.
Though it can be embarrassing to talk about issues involving your sexual function and your penis not doing what you want it to do, your healthcare provider is the best person to help you rule out underlying medical conditions and determine the optimal form of treatment.
Your healthcare provider will review your medical history and perform a physical exam to find the underlying cause of your erectile issues and discern whether Viagra might help.
With a prescription from your healthcare provider, you can purchase Viagra at just about any pharmacy you choose. Just keep in mind that you’ll most likely be given the generic version, sildenafil.
Generic medications contain the same active ingredient, but they are priced much lower than brand-name medication because the manufacturer doesn’t have to spend years researching and developing the drug.
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Is Viagra Covered? Takeaways
Erectile dysfunction can be a frustrating, and even embarrassing, issue to deal with, whether it occurs rarely or on a regular basis. Fortunately, ED is very treatable.
The cost for the medications that will help you may not be ideal, and you may not get coverage from certain health plans, but Viagra and other erectile dysfunction drugs are more affordable than in past decades.
Here are the important takeaways for men looking at the cost and coverage for Viagra:
Viagra and other PDE5 inhibitors are considered the first-line treatments for erectile dysfunction. But for many insurance companies, they’re not medically-necessary treatment.
Some plans will only cover the brand-name drug if your healthcare provider indicates you have a medical need for it or if you’ve tried the generic and experienced serious side effects.
Generally speaking, neither Medicaid nor Medicare will cover Viagra or its generics for ED.
Luckily, the prices of Viagra and sildenafil have fallen steeply in the last two decades.
If you don’t have a primary care healthcare provider, you may be able to purchase Viagra or sildenafil online. Be careful if you go this route, however, because Viagra is one of the most frequently counterfeited drugs on the market due to its popularity. Do your research to find a telehealth provider and/or licensed online pharmacy if you want to buy Viagra online.
Want more information? We can help.
Check out our complete guide to erectile dysfunction to learn what causes ED and what you can do to treat it.
A quick chat may be all you need to get you started on the path toward more satisfying and consistent sexual performance. Talk to your healthcare provider about Viagra or complete an online consultation with a licensed healthcare provider to get a prescription. All it takes is a few minutes to start treating ED safely and discreetly.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.