Is Cialis Covered By Insurance?
Dealing with health insurance is like dealing with erectile dysfunction (ED): frustrating.
If your healthcare provider recommended Cialis®, a prescription treatment for erectile dysfunction, you’re probably wondering if Cialis is covered by insurance.
Cialis is a brand-name drug, which can make it pretty costly. To get specific, it can cost upwards of $450 per month. If you’re saying, “Yikes,” you’re not alone. Many people simply can’t afford Cialis without health insurance.
The good news is that some — but not all — health insurance plans cover Cialis and other ED treatments.
The better news is that there are other, more affordable ways to access Cialis. If you don’t have insurance or if your insurance doesn’t cover Cialis, you can get the generic version — tadalafil — for as little as $23 to $30 for a 30-day supply.
So before you take your Cialis prescription to the pharmacy, let’s talk about insurance coverage, the cost of Cialis and some affordable alternatives.
Does Insurance Cover Cialis (Tadalafil)?
In short, it depends on your insurance plan. While some policies cover Cialis, others don’t.
Cialis is a brand-name drug containing the active ingredient tadalafil. Depending on your prescribed Cialis dosage, it can be used prior to sexual activity or as a once-a-day pill. This is a prescription-only drug, meaning you can’t buy it over the counter.
First approved by the U.S. Food and Drug Administration (FDA) in 2003, Cialis is a phosphodiesterase 5 (PDE5) inhibitor. PDE5 inhibitors work by improving blood flow to the penis, making it easier to get an erection.
Cialis is perhaps best known as an erectile dysfunction treatment. However, it can also be used to treat other medical conditions, like benign prostatic hyperplasia (BPH) and pulmonary arterial hypertension (PAH).
Over 30 million U.S. men experience erectile dysfunction. The condition doesn’t just affect your sexual health — it can also impact your relationships, self-esteem and mental health.
That’s why it’s crucial for people to be able to access ED medication. If your erectile function is bothering you, it’s worth prioritizing your treatment.
Not all health insurance plans recognize the importance of treating ED. Certain plans may cover Cialis, in which case access it while only paying a small copay. However, most insurance companies only pay for Cialis under very specific circumstances.
It’s a good idea to get a hold of your plan’s policy and check your prescription drug coverage. If you don’t have a hard copy of your benefits document, you can probably find the policy on your insurance’s website. Look for the “formulary,” which lists the drugs covered under each plan.
We also recommend calling your insurance company directly to ask. Though calling them might sound like a schlep, it’s worth getting some clarity on your coverage and benefits.
Many insurance plans only cover Cialis in specific situations. For instance, the medication might only be covered if:
You’re using Cialis for BPH (as opposed to erectile dysfunction)
Other ED treatments haven’t worked for you
Your healthcare provider writes a motivational letter (what’s known as prior authorization) on your behalf
Certain insurance companies only cover generic drugs for the treatment of erectile dysfunction. This could include tadalafil (generic Cialis).
Does Medicaid or Medicare cover Cialis and other ED treatments? Typically, no.
Medicare coverage doesn’t include Cialis, as it doesn’t consider erectile dysfunction drugs medically necessary (Which is unfortunate, because sexual health can be a vital part of your overall health!).
However, certain Medicare drug coverage plans — like Medicare Part D or Advantage Plan — may cover tadalafil if it’s prescribed for other health issues (like BPH or cardiovascular conditions) and not for the treatment of erectile dysfunction.
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How to Get Cialis Without Insurance Coverage
So, your health insurance isn’t covering your Cialis prescription, and in this economy, you can’t afford to spend the extra $450 (or more) a month. Yep, that’s how much Cialis costs out of pocket.
You want to break the bed here — not the bank.
Fortunately, there are some cost-effective alternatives.
You could try tadalafil, the generic version of Cialis. There’s little difference between Cialis and tadalafil — while Cialis is the brand name version, it’s not necessarily superior to tadalafil.
The cost of tadalafil is way lower than Cialis. You can buy a month’s supply for $23 – $35, depending on the tadalafil dosage prescribed to you.
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Traditional Pill
SildenafilGeneric equivalent to 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®
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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.
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As-Needed TadalafilGeneric Cialis®
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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.
If your insurance doesn’t cover Cialis, it may cover other erectile dysfunction treatments, like:
Viagra®, another brand-name erectile dysfunction drug
Sildenafil, also called generic Viagra
Stendra® (avanafil), an ED treatment that can work in as little as 15 minutes
Revatio®, a medication FDA-approved for pulmonary arterial hypertension that can also be used off-label in its generic form (sildenafil citrate) to treat erectile dysfunction
Our hard mints, which are chewable ED meds that contain Cialis
These are all prescription medications. As with all drugs, PDE5 inhibitors may have certain side effects and risks, so it’s important to seek medical advice before using them.
Certain lifestyle changes can also help prevent and reduce erectile dysfunction. This may include:
Getting enough good-quality sleep
Eating a balanced, nutrient-dense diet
Avoiding cigarettes and alcohol
Getting regular exercise
Communicating openly with your partner
Reducing stress wherever possible
If Cialis is your only option, you can try the Lilly Cares® Foundation, a patient assistance program run by Eli Lilly, the manufacturer of Cialis.
Get effective, affordable ED treatment... from your home!
The Bottom Line on Cialis and Insurance Coverage
Some health insurance plans cover Cialis — but not all of them do. It depends on the insurance you use and the specific benefits of your plan.
Here’s what to keep in mind:
Call your insurance provider. It’s a good idea to peek at your policy documents to find out whether your insurance will cover ED treatments — but it’s best to phone your insurance directly.
There’s an affordable generic version of Cialis. Tadalafil is pretty much the same thing as Cialis — just much cheaper. Your insurance might cover tadalafil, or you could pay as little as $23 per month out of pocket with an online prescription.
Consider other erectile dysfunction treatments. Your health insurance might not cover Cialis but instead cover other prescription ED treatments, like Viagra, sildenafil or Stendra (brand-name avanafil).
If you have erectile dysfunction, it can be helpful to learn more about your treatment options. Check out these natural tips for treating ED and our guide to the most common erectile dysfunction treatments.
Ready to take the next step? We can connect you with a licensed healthcare professional online. Book an appointment today to explore your treatment options.
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.