Is sildenafil covered under Medicare?

Asked by: Terrell Quigley  |  Last update: December 23, 2022
Score: 5/5 (53 votes)

Summary. Medicare does not cover Viagra and similar drugs for the treatment of ED. However, Medicare may cover sildenafil and other generic medications for ED to treat other medically necessary conditions. For treatment of ED, people may be able to get the generic forms at a lower cost than the brand name drugs.

Does Medicare pay for sildenafil?

Yes, most Medicare Part D plans cover generic sildenafil. Sildenafil is typically a Tier 2 medication.

Does Medicare cover Viagra for erectile dysfunction?

Medicare generally does not cover Viagra or other medications for ED treatment. Under Medicare guidelines for coverage, these medications are not considered medically necessary. However, more generic versions of ED medications have recently become available.

Does Medicare cover erectile dysfunction treatment?

Medicare doesn't typically cover erectile dysfunction oral medications or injections. However, penile implant surgery is partially covered by Medicare for those who qualify. Diagnosing erectile dysfunction, or ED, typically requires you to answer a few questions and undergo a physical exam from your doctor.

Does Medicare pay for Viagra and Cialis?

Medicare coverage for erectile dysfunction prescriptions may have coverage under Part D. Most brand name medications for erectile dysfunction, such as Viagra, Cialis, and Levitra, are not covered under Part D. However, the generic versions have some coverage.

Why Doesn't Medicare Cover THIS???

31 related questions found

What is the average cost of sildenafil?

Viagra costs an average of about $70 per pill, while the cost for generic pill sildenafil can start at about $8.50 a pill, according to online retailers. By using an online subscription service, sildenafil pills can be as low as $2 per pill.

Does Medicare cover Viagra cost?

Medicare does not cover Viagra and similar drugs for the treatment of ED. However, Medicare may cover sildenafil and other generic medications for ED to treat other medically necessary conditions. For treatment of ED, people may be able to get the generic forms at a lower cost than the brand name drugs.

Is Cialis covered by Medicare?

It is available in both brand and generic versions. Cialis is not covered by most Medicare and insurance plans, but manufacturer and pharmacy coupons can help offset the cost.

Why is Viagra not covered by insurance?

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.

Does any insurance cover Viagra?

Viagra, in its brand name form, is not covered on insurance plans from most insurance companies. However, many medicare coverage options and health plans offer insurance coverage for it under their prescription drug coverage.

Is sildenafil as good as Viagra?

The takeaway

Generic Viagra, or sildenafil citrate, works the same as Viagra, but at a lower cost. While Pfizer still manufactures the “little blue pill,” other companies, globally and in the United States, make sildenafil. It may look different, but it's still an effective treatment for ED.

What is the difference between sildenafil and Viagra?

The difference is that Viagra is a brand name medication invented and marketed by Pfizer, while sildenafil (or sildenafil citrate) is the generic name for the ingredient in Viagra that's responsible for its positive effects on treating erectile dysfunction.

Are erectile dysfunction drugs covered by insurance?

Under the law, drugs used to treat erectile or sexual dysfunction are excluded from Part D coverage unless they are used as part of a treatment approved by the Food and Drug Administration for a different condition.

Is tadalafil covered by Medicare Part D?

Most Medicare Part D drug plans do not cover tadalafil if prescribed to treat ED. However, plans may cover tadalafil when prescribed to treat BPH or PAH.

Is generic sildenafil covered by insurance?

This drug is more popular than comparable drugs. It is available in generic and brand versions. Generic sildenafil is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower.

Do you need a prescription for generic sildenafil?

Yes. You need a prescription for both Viagra and generic sildenafil. You can get a prescription either in person or online. With an ever-growing number of telehealth companies providing remote services, it's easier than ever to skip an in-person doctor's visit and request a prescription online.

How do I get a prescription for sildenafil?

Just like Viagra, Sildenafil requires a prescription from a doctor. You can buy sildenafil online by making an appointment with a PlushCare physician and getting your prescription sent to the pharmacy of your choice.

Is Cialis better than tadalafil?

Generic Cialis, or Tadalafil, is the same as Cialis in terms of its active ingredient (tadalafil), its effectiveness and side effects. The difference you may see is in the cost, with generic medicines tending to be less expensive.

Why is Cialis not covered by insurance?

In many cases, health insurance and Medicare Part D prescription plans do not cover Cialis. That's because ED medications are often considered lifestyle-related rather than medically necessary.

How much does Cialis cost per pill?

The price of brand name Cialis can range from $12 to upwards of $70 per tablet, depending on the specific dosage of the medication. For a month's supply, typical pricing ranges from $380 to $1,000 or more, again depending on the dosage you're prescribed.

What are the side effects of sildenafil?

Side Effects
  • Bladder pain.
  • burning feeling in the chest or stomach.
  • cloudy or bloody urine.
  • increased frequency of urination.
  • pain on urination.
  • stomach upset.
  • tenderness in the stomach area.

Does Blue Cross Blue Shield cover erectile dysfunction?

For instance, some large group plans under Blue Cross Blue Shield appear to cover a portion of the cost of Viagra, as well as other phosphodiesterase-5 (PDE5) inhibitors (the drug class Viagra is a part of), such as Cialis and Levitra (Blue Cross Blue Shield, 2021).

Does Medicare cover erectile dysfunction pumps?

Medicare benefits are typically reserved to pay for medically necessary treatments that are ordered by a physician. As a result, Medicare does not generally pay for ED pumps unless the use of such devices is an integral part of a larger treatment approach to a serious medical condition.

Does sildenafil keep you hard after coming?

Viagra is also prescribed for many men with early ejaculation. Viagra helps to maintain the erection after ejaculation and reduces the refractory time before a second erection can be obtained.