Medicare usually does not pay for Viagra and similar drugs, such as Cialis and Levitra, that people use to treat sexual dysfunction.
However, the generic version of the drug, which is called sildenafil, is available at a lower cost. A person who needs the medication may find coupons online that further lower the price.
This article discusses whether Medicare covers Viagra, the costs of Viagra, the drug’s generic alternatives, and how Viagra works.
Original Medicare includes Part A, which is inpatient hospital insurance, and Part B, which is medical insurance. Neither Part A nor Part B includes general prescription drug coverage, which is available under Part D.
Part A will pay for some medications that need administering if a person is in a skilled nursing facility. Part B also covers some outpatient medications in limited form.
Original Medicare will not cover the brand name drug Viagra. However, there is a possibility that it might cover the generic form of the medication, sildenafil, in rare cases if a doctor prescribes it for a different, medically necessary condition.
The reason for this is that sildenafil can treat conditions other than erectile dysfunction (ED). For example, doctors may use the generic version of Viagra to treat pulmonary arterial hypertension.
To help with uninsured healthcare costs, some people with original Medicare buy a Medigap plan, which is a Medicare supplement insurance. However, it does not provide drug coverage.
Advantage plans are an alternative to original Medicare. They must provide the same coverage as parts A and B, and, in most cases, they also include prescription drug coverage. However, the plans usually do not cover Viagra and similar brand name drugs.
Some plans cover the generic versions of these medications, though. A person can check their particular Advantage plan to see what drugs it covers.
Similar to original Medicare, Medicare Part D, which covers medications, sees the treatment of ED as lifestyle-enhancing rather than medically necessary.
In general, Part D does not cover drugs that treat ED, including Viagra, unless a doctor prescribes them for different, medically necessary indications for which the Food and Drug Administration has approved their use.
However, some Part D plans may not cover Viagra, or even sildenafil, if a doctor prescribes it off-label to treat a different medical condition, even if the doctor states that it is medically necessary.
Prices for Viagra can vary considerably among pharmacies. However, it can cost more than $600 for 10 of the 50-milligram (mg) tablets. Generic versions will generally cost less than the branded version.
In some cases, a person may be able to find coupons online from retailers that can cut the cost. This makes the pills more affordable for many people, even if they do not have health insurance.
The drug manufacturer Pfizer also has a Patient Assistance Program for some of its drugs, including Viagra, This program makes the drugs available for free in certain circumstances.
Viagra is a pill that people use if they have difficulty achieving an erection during sexual activity. It works by increasing the availability of a key body chemical.
An erection requires the release of a chemical called nitric oxide (NO) during sexual stimulation.
NO allows the smooth muscles in the penis to relax, which permits the increased blood flow that results in an erection. Viagra increases the effect of NO by suppressing the enzyme responsible for its breakdown.
The FDA states that for most people, the recommended dose is 50 mg, which it is best to take 1 hour prior to sexual activity. A person may also take it from 30 minutes to 4 hours beforehand, though.
However, a doctor may prescribe a starting dose of 25 mg for individuals who are over the age of 65 years or have reduced liver or kidney function.
The FDA also reports on eight studies that compare the effects of Viagra and a placebo on male participants with sexual dysfunction. The research showed that sexual stimulation resulted in a better erection in those who took Viagra.
It is important to note that Viagra may cause side effects, such as flushing of the face, headaches, and diarrhea.
A person should talk with their doctor about all their current medications and health conditions before using Viagra.
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.
A person with sexual dysfunction may wish to discuss the condition with their doctor and ask whether it is safe for them to take Viagra or its generic alternative. A doctor can give them a prescription and perhaps recommend other measures.