Is Viagra Covered by Insurance?

For more than 30 million men in the United States alone, erectile dysfunction (ED) stands in the way of great sex, leading many to explore medication as a treatment. Enter: the problem of cost. 

The cost of Viagra can be prohibitive for some men, leading them to google questions about how to pay for it. Does insurance cover Viagra? What about generics — is sildenafil covered by insurance?

Unfortunately, with few exceptions, the answer is often no. Viagra may not be covered by insurance, but it can be more affordable if you know how to get safe access to generics.

Below, we’ve explained insurance coverage for Viagra® and other ED pills, how Medicaid and Medicare determine coverage for Viagra and what your out-of-pocket cost may look like if you qualify for coverage.

Here’s the bad news about insurance coverage for Viagra: brand-name drug Viagra is generally not covered by almost all insurance plans. Each plan differs in its coverage policies, so you’ll need to check with your insurance provider to verify your prescription drug coverage and to see whether brand-name Viagra is covered. 

Viagra has been around since the late 90s, but now, many generic versions exist under the name sildenafil. Nowadays most PDE5 inhibitors are available as generics, which means you may not need a brand name that’s not covered. 

Some insurers may cover sildenafil even when they don’t cover Viagra. Generally though, medications for erectile dysfunction are not covered — especially brand-name versions.

Most insurance plans don’t cover 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. 

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.

As we noted, it’s unlikely that your insurance will cover Viagra. But even if insurance does cover it, the good news is that the price of Viagra is much lower now.

One reason for this is the availability of those generics we mentioned. Viagra is an FDA-approved brand-name medication developed and marketed by Pfizer. 

At a certain point, other drug companies are able to make generic versions of brand-name drugs, which is why sildenafil is 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 Viagra as you would the same dose of generic sildenafil. 

Regardless of your insurance coverage, it’s likely that sildenafil will be more affordable than Viagra According to the U.S. Food and Drug Administration (FDA), generic drugs cost up to 85 percent less than the same brand-name medication.

Does Medicare pay for Viagra? Probably not. Unfortunately, if you have Medicare coverage, your prescription drug coverage may be limited and probably won’t include Viagra. 

Viagra and other prescription drugs for ED are considered elective (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 assessment from the health insurance industry; 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  lead to 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.

Does Medicaid Cover Viagra?

For the most part, Medicaid doesn’t consider 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.

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 simplest 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.

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 were much higher when the drug was first introduced to the market than they are today.

• At peak, the price for a single pill without insurance coverage was more than $88.

• 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.

Erectile dysfunction treatment can be a frustrating 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 now 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 considered 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.