What to Know About Medicare Coverage for Viagra (2024)

Most Medicare plans do not cover erectile dysfunction (ED) medications like Viagra, but some Part D and Part C plans may help cover generic versions.

Viagra (sildenafil) is the most recognized medication for treating erectile dysfunction (ED). It works by increasing blood flow to the penis to help get or maintain an erection. It does not affect arousal.

Medicare generally does not cover Viagra or other medications for ED treatment. Under Medicare guidelines for coverage, these medications are not considered medically necessary.

Viagra was also the most prescribed medication to treat ED until new generic versions became available. The generic versions are much more affordable, even without insurance.

Let’s take a closer look at Medicare plans and how they address Viagra coverage.

Original Medicare does not cover Viagra.

Medicare has four different parts (A, B, C, and D), and each covers prescription medications differently. Parts A and B are also referred to as original Medicare. Medicare Part A covers costs related to:

• inpatient hospital stays
• hospice
• skilled nursing
• home healthcare

Part A does not cover Viagra or other ED medications.

Medicare Part B covers:

• outpatient doctor visits
• preventive screenings
• counseling
• some vaccines and injectable medications given by a healthcare professional

Viagra and other medications for ED are not covered under this plan.

Medicare Part C, or Medicare Advantage, is a private insurance option that offers all the benefits of parts A and B. Medicare Part C also covers prescription drug benefits and other extras like dental, vision, and fitness memberships. There are HMO, PPO, PFFS, and other types of plan options available.

Although Part C plans offer extra benefits, there may be restrictions on in-network doctors and pharmacies.

Typically, Part C plans with prescription drug coverage do not cover Viagra or similar medications for ED. Some plans may cover generic versions. You need to check your specific plan to see which drugs are covered.

You can also try to appeal a coverage decision. To do this, a doctor would need to write a letter to your insurance company explaining why the medication is medically necessary.

Medicare Part D does not typically cover Viagra.

Private insurance companies also offer Medicare Part D with plans approved by Medicare. You must be enrolled in original Medicare to be eligible to enroll in a Part D plan. Costs and types of coverage vary based on where you live. There are typically hundreds of plans to choose from in any given state.

Choosing a Part D plan

Although Medicare Part D plans do not generally cover ED medications, they do usually cover another brand of sildenafil called Revatio. Revatio is used to treat pulmonary arterial hypertension (PAH), a condition involving high blood pressure in the lungs’ arteries.

You can go to Medicare.gov’s Find a Medicare Plan tool to compare rates and drug coverage before choosing a plan.

Each plan has a formulary that lists the specific drugs that it covers. Check to see if Viagra or a generic ED medication is listed as covered. You can also call the plan’s provider and ask if Viagra is covered.

Medigap is an add-on coverage plan to help pay for coinsurance, deductibles, and copayment expenses not covered by original Medicare.

Medigap plans do not pay for prescription medications. Viagra would not be covered under any Medigap plan.

The brand version of Viagra is a fairly expensive medication. The typical cost for one tablet is about $100. You can check for discounts and coupons offered by the manufacturer and other programs to lower costs.

The good news is that generic versions are now available and driving down costs. Generic sildenafil costs a fraction of what the Viagra brand medication does, making it more affordable and accessible for people with ED.

Even without insurance, the average cost for a 25 mg dose of generic sildenafil costs about $30 for 30 tablets by using a coupon at retail pharmacies.

You can look for coupons on drug manufacturers’ websites, medication discount websites, or from your preferred pharmacy. Prices can be different at each pharmacy, so check before you go.

Without a coupon or insurance, you may pay more than $460 for 30 tablets.

Tips for saving money on your ED medication

• Talk with a doctor: Discuss your symptoms with your doctor and ask if generic sildenafil would be right for you.
• Shop around: Ask for prices at different retail pharmacies to find the best price. Prices can be different at each pharmacy.
• Check for coupons: You can search for coupons to lower the cost of these medications from the manufacturer, your pharmacy, or a prescription discount website.
• Look into Viagra discounts: Ask your doctor if there are any manufacturer discounts or patient assistance programs that you may qualify for.

Several other treatment options for ED are available. Other oral medications in the same class as sildenafil include avanafil (Stendra), tadalafil (Cialis and Adcirca), and vardenafil (Levitra and Staxyn).

Other available medical options include:

• testosterone in injectable, pellet, oral, and topical forms
• vacuum pumps
• alprostadil urethral suppository (Muse)
• blood vessel surgery
• injectable alprostadil (Caverject, Edex, Muse)
• shock wave therapy
• Eroxon, which is available as an over-the-counter topical gel

Many factors can cause ED. These causes can be physical, psychological, environmental, or related to certain medications. You can talk with a doctor about the possible causes of your ED and whether certain lifestyle changes may help relieve your symptoms. This can include:

• talk therapy or sex therapy for anxiety, stress, and other psychological causes of ED
• counseling for relationship concerns
• kegel exercises
• other physical exercises
• dietary changes
• medication changes

Acupressure and herbal supplements may advertise treatment for ED, but there is no confirmed scientific evidence to prove these claims. Always check with your doctor before taking herbal or natural supplements. They may interact with your medications or cause side effects.

ED is a common condition affecting millions of men. Medicare plans generally do not cover Viagra, but there are many generic options available that make medication much more affordable, even without insurance.

It’s important to address the underlying causes of ED. Talk with your doctor about any health concerns possibly related to ED. Consider all treatment options that could be helpful, including healthy lifestyle changes and therapy for psychological or relationship concerns.