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Does Insurance Cover Viagra?

You have the right to enjoy a healthy sex life no matter your age. For 30 million men in the United States alone, however, erectile dysfunction (ED) makes it challenging to achieve and maintain an erection firm enough for satisfying sex. 

Erectile dysfunction can affect men of any age, but it is more common in middle-aged and older men. In fact, research suggests your risk for ED increases by 10 percent for each decade. 

Whether erectile dysfunction is something you struggle with on occasion or it’s becoming a chronic issue, you’ll be glad to know treatment options exist. Erectile dysfunction medications like Viagra® (sildenafil) relax the blood vessels and improve blood flow to the penis, making it easier to achieve an erection when you want to. 

Viagra has been around since the late 90s but is still only available with a prescription in the United States. In this guide, we’ll explore the options for purchasing Viagra and answer questions regarding insurance coverage. 

Viagra vs. Sildenafil 

When your healthcare provider writes you a prescription and you take it to the pharmacy, the pharmacy will most likely fill it with the generic form of the drug. 

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. According to the U.S. Food and Drug Administration (FDA), generic drugs cost up to 85 percent less than the same brand-name medication. 

Many insurance companies won’t automatically cover brand-name drugs if a generic 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. 

Viagra is a brand-name medication developed and marketed by Pfizer. 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 in taking a 25mg to 100mg dose of Viagra as you would an identical dose of generic sildenafil. 

Ways to Purchase Viagra 

Remember, Viagra is only available by prescription, so you won’t be able to purchase it over-the-counter. The best way to get a prescription is to speak to your primary care provider. 

Though it can be embarrassing to talk about issues involving your sexual function, 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 to 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 you’ll 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 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 licensed online pharmacy if you want to buy Viagra online.

Does Insurance Cover Viagra? 

Every insurance plan is different, so you’ll need to check with your provider to verify your prescription drug coverage and to see whether Viagra is covered. 

When it comes to coverage for erectile dysfunction drugs, most insurance plans don’t cover brand-name medications like Viagra, Cialis® or Levitra®. These are all PDE5 inhibitors — drugs that inhibit the action of a specific enzyme which regulates blood flow to the penis — which are considered the first-line of treatment for erectile dysfunction

Even if your insurance plan doesn’t cover Viagra, it may cover the generic form of the medication sildenafil. 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. 

What About Medicare? 

Unfortunately, if you’re on Medicare your prescription drug coverage may be limited. 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. 

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 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 the generic sildenafil. 

In Conclusion 

Erectile dysfunction is a common issue affecting millions of men of all ages. 

Viagra is an FDA-approved medication designed to treat erectile dysfunction and it could help you overcome biological factors affecting your sexual performance. Though taking Viagra won’t immediately give you an erection, it may make it easier to get an erection when you want to.  

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. 

Learn More About Treating ED

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. 

Check out our complete guide to erectile dysfunction to learn what causes ED and what you can do to treat it. A quick chat with your healthcare provider may be all it takes to get you started on the path toward more satisfying and consistent sexual performance. 

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.