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Does Insurance Cover Viagra?


Picture of Viagra tablets with a heading Is Viagra Covered by Insurance

Does Insurance Cover Viagra? 

Erectile dysfunction (ED) is a common issue affecting millions of men across various age groups. Viagra, a popular prescription drug that treats ED, has existed since the late 90s. However, its availability and coverage by insurance plans remain a concern for many individuals. 

This comprehensive article will explore the options for purchasing Viagra, the cost and insurance coverage, and alternatives to Viagra.

Viagra vs. Sildenafil: Understanding the Difference

Viagra is a brand-name medication developed and marketed by Pfizer. Sildenafil, also known as generic Viagra, is the active ingredient in Viagra and the name of the generic version. Both drugs contain the same active ingredient, which means you can expect the same results when taking a 25mg to 100mg dose of Viagra as you would an equivalent dose of generic sildenafil.

Generic medications are typically priced much lower than brand-name ones because manufacturers do not have to spend years researching and developing the drug. According to the U.S. Food and Drug Administration (FDA), generic drugs can cost up to 85 percent less than the same brand-name medication.

Many insurance companies are reluctant to cover brand-name drugs if a generic version is available. 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.
Related: Sildenafil vs Viagra

Purchasing Viagra: What Are Your Options?

Viagra is only available by prescription in the United States, so you cannot purchase it over the counter. The best way to get a prescription is to speak to your primary care provider or through online telemedicine services such as BlueChew or Hims. 

While discussing your sexual health with a provider may feel uncomfortable, your healthcare provider is the best person to help you rule out underlying medical conditions and determine the optimal treatment. 

With a prescription from your healthcare provider, you can purchase Viagra at just about any pharmacy you choose. Remember that you will most likely be given the generic version, sildenafil.

If you don’t have a primary care healthcare provider, you may be able to purchase Viagra or sildenafil online. Be cautious when searching for a licensed online pharmacy to buy Viagra, as it is one of the most frequently counterfeited drugs due to its popularity.

Determining Insurance Coverage for Viagra

Every insurance plan differs, so you must check with your provider to verify your prescription drug coverage and whether Viagra is covered. Many insurance plans do not cover brand-name medications like Viagra, Cialis, or Levitra if a generic version is available.

Even if your insurance plan does not cover Viagra, it may cover the generic form of the medication, sildenafil. If your plan does not cover sildenafil either, you may be able to submit an appeal for coverage or obtain prior authorization to get the prescription covered.

Medicare and Viagra Coverage

Unfortunately, your prescription drug coverage may be limited if you’re on Medicare. Viagra and other prescription drugs aren’t covered under Original Medicare Parts A and B, but you may have some prescription drug coverage under Medicare Part D.

You must purchase a stand-alone Medicare Part D Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug (MA-PD) plan to receive prescription drug coverage through Medicare. 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 the 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 generic sildenafil.

Medicaid and Viagra Coverage

Medicaid coverage for Viagra and other ED medications varies between states and plans. In general, there’s a better chance of one of the generic versions, such as sildenafil citrate, tadalafil, or vardenafil, being covered under your Medicaid plan than their brand-name counterparts. Check your specific state’s Medicaid program for more information on coverage options.

Out-of-Pocket Cost for Viagra

If your insurance plan does not cover Viagra, the out-of-pocket drug costs can be quite high. It can cost up to $2,000 for 30 pills of a 100 mg dose. Every pharmacy offers its rates, so it’s worth shopping around. Other PDE5 inhibitors, such as Cialis and Levitra, may be slightly more affordable but still pricey.

Telehealth options, such as Hims, BlueChew, or Roman, can help you access Viagra or a generic for a lower cost and deliver it directly to your door.

Cheaper Alternatives to Viagra: Sildenafil and Revatio

Two cheaper versions of Viagra are available: generic Viagra (sildenafil) and generic Revatio. Both drugs have the same active ingredient as Viagra, sildenafil citrate.

Revatio is an FDA-approved medication for treating a specific type of lung high blood pressure. Revatio has the same active ingredient as Viagra but is available only in 20 mg tablets. Some healthcare providers prescribe generic Revatio at doses of 20 mg, 40 mg, 60 mg, 80 mg, or 100 mg to treat ED. 

However, this is considered off-label prescribing since Revatio and its generic form are not specifically FDA-approved for ED. Generic Revatio is much more affordable than Viagra, available for as low as $10 for 30 doses of 100 mg (depending on the pharmacy).

How Viagra Treats Erectile Dysfunction

Viagra, Cialis, Levitra, and their generic counterparts are all examples of PDE5 inhibitors, medications that treat erectile dysfunction by blocking an enzyme called PDE5. Blocking PDE5 with PDE5 inhibitors causes better blood flow to the penis, resulting in stronger and longer-lasting erections.
Related: How does Viagra work 

Purchasing Viagra: Making the Right Choice for Your Budget

These medications work similarly, with some differences in how long they last in the body and their side effects. Ultimately, your medication will depend on your healthcare professional’s medical advice and what fits your budget best. 

Call your insurance provider to determine if any of these medications are covered under your plan. If they need to be covered, shop around for the most affordable options offered by different licensed pharmacies.

Conclusion

Viagra and other ED medications can be crucial in maintaining a healthy sex life and overall quality of life. Understanding your insurance coverage and exploring alternative options can help make ED treatment more affordable and accessible. 

By discussing your needs with your healthcare provider and insurance company, you can find the best solution to manage your erectile dysfunction and regain control of your sexual health.

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