June 12th 2024
By Ari Parker
While Medicare doesn't cover Viagra, it does cover generic alternatives if you meet certain health conditions. Learn more in this guide.
By Ari Parker
Erectile dysfunction is a major concern for many older men—almost 70% of men are affected by erectile dysfunction by the time they turn 70. Maintaining your sexual health at an older age can improve your overall well being, and understanding your Medicare coverage is a great first step.
Medicare doesn’t cover Viagra or any medication to treat erectile dysfunction if it isn’t medically necessary. However, there are other ways Medicare can help you manage erectile dysfunction and improve your sexual health.
Medicare doesn’t cover Viagra or any brand name drug to treat erectile dysfunction.
Sildenafil is the generic form of Viagra, and it can also be used to treat pulmonary arterial hypertension (PAH).
All Medicare prescription drug plans cover generic sildenafil medications if used to treat PAH or an underlying condition that may cause erectile dysfunction.
Medicare covers other services for sexual health, like STI screenings, doctor visits, and counseling.
Viagra is a brand name version of sildenafil, a drug used to treat erectile dysfunction in men. It works by blocking an enzyme called PDE5, which is responsible for regulating blood flow in the penis. This causes blood vessels to relax and increases blood flow during sexual stimulation.
Sildenafil can also be used to treat pulmonary arterial hypertension (PAH), a serious condition that involves high blood pressure in the lungs. Revatio is the generic version of sildenafil that’s also used to treat PAH.
Original Medicare (Part A and Part B) doesn’t provide drug coverage. Medicare Part D is your prescription drug coverage. You can get Medicare Part D through a standalone plan or bundled with a Medicare Advantage plan. Original Medicare and Medicare Advantage can help cover services for managing other aspects of sexual health, which we’ll explore later on in the article.
Medicare prescription drug plans don’t cover Viagra, Cialis, or any brand name drug specifically intended to treat erectile dysfunction and with no other medical purpose. Viagra only treats erectile dysfunction. Medicare doesn’t consider the treatment to be medically necessary and won’t provide coverage.
That said, 100% of Medicare drug plans cover generic sildenafil medications since they also treat pulmonary arterial hypertension. It’s unlikely that Medicare will cover generic versions of sildenafil for erectile dysfunction without a medical reason. However, many men experience erectile dysfunction as a result of an underlying medical condition or as a side effect to a certain medication.
Your doctor may prescribe sildenafil to treat PAH or erectile dysfunction as a symptom of another medical condition. In either of these situations, your Medicare drug plan would cover a generic sildenafil medication, like Revatio.
Viagra is expensive if you need to pay for it yourself. The price for 30 tablets can be around $2,730!
On the other hand, generic sildenafil is much cheaper at $9.30 to $45 for 30 tablets. You could also get pharmacy and online discounts to make these drugs even less expensive. With Medicare Part D, if you meet coverage criteria, you’re looking at about a $0-7 copay, depending on your drug plan.
In some cases, Medicare may cover penile implant surgery if the procedure is medically necessary. This surgery involves implanting a prosthetic device into the penis to achieve an erection. Doctors usually recommend penile implant surgery if other treatments haven’t been working. Consult with your healthcare provider about the best course of action for you.
It’s important to know that your Medicare coverage can help you manage your overall sexual health. Since erectile dysfunction can be a symptom of another medical problem, you can use Medicare to pay for doctor visits and services to diagnose and treat related conditions.
If erectile dysfunction is a side effect of another medication, you can ask your healthcare provider to switch to another drug that may not cause the same issues. Make sure you check your drug plan’s formulary to see which medications are covered before switching.
Medicare also covers preventive screenings and counseling for STIs and doctor visits for sexual health consultations.
If you have more questions about your Medicare coverage or you’d like to explore your drug plan options, call us at 855-900-2427 or schedule a time to chat today.
