Doctors usually prescribe Viagra to treat Erectile Disfunction (ED). The tablet gets absorbed in the digestive tract and increases the blood flow to the penis. As a result, you can maintain an erection for a longer time. 

But does Medicare cover Viagra for erectile dysfunction? 

Does Original Medicare cover Viagra? 

Unfortunately, Original Medicare does not cover Viagra or any other prescription drug used to treat erectile dysfunction.

Does Medicare Part D cover Viagra?

Regarding Viagra or similar drugs used for treating erectile dysfunction, coverage under Medicare Part D can vary depending on the specific plan. Some Part D plans may cover these medications, while others may not. 

It’s crucial to review the formulary, or list of covered drugs, of your Part D plan to determine if Viagra is included and to understand any associated costs.

Does Medicare cover generic Viagra (Sildenafil)? 

Sildenafil belongs to a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. It works by inhibiting the enzyme PDE5, which regulates blood flow. By blocking this enzyme, Sildenafil helps increase blood flow to specific areas of the body.

This helps to treat erectile dysfunction and pulmonary arterial hypertension. So, yes, Medicare Part D covers generic Viagra or Sildenafil as tier-two medication. 

Important!

• Sildenafil, Viagra, and Revatio all contain the same active ingredient – sildenafil citrate. However, they are used to treat different medical conditions, which affects Medicare Part D coverage.  
• Sildenafil can be used for both pulmonary arterial hypertension and erectile dysfunction. So, Medicare covers it under Part D. 
• Viagra is primarily used for erectile dysfunction in men. So, while Original Medicare doesn’t cover it, some Part D plans may cover it.
• Revatio is used by both men and women to treat pulmonary arterial hypertension. So, most Medicare Part D plan cover it. 

Does Medicare Advantage cover Viagra?

Medicare Advantage (also called Part C) plans often include additional benefits like prescription drug coverage, dental, vision, and wellness programs. This makes them a great option for those seeking a comprehensive healthcare plan.  

However, when it comes to Viagra, Medicare Advantage plans vary in whether they cover it or not. Most plans will offer you alternatives or generic Sildenafil. So, it’s best to review the specific plan details to understand coverage and any associated costs.

Why doesn’t Medicare cover Viagra?

As discussed, Viagra is not covered under Original Medicare (Part A and B). It’s also difficult to find Viagra coverage in Part C and D plans. This is because Medicare only covers medically necessary drugs. 

When Viagra was introduced, it was categorized as a lifestyle drug rather than a medication necessary for the treatment of a specific illness. People still use it to enhance the quality of their life. 

Since Medicare only focuses coverage on drugs that treat medical conditions or diseases, it does not cover Viagra. You have to bear the full cost in most cases. 

However, it’s also important to note that coverage decisions can evolve over time. Some Medicare Part C and D plans may provide coverage for Viagra if it has been prescribed by the doctor. 

How much does Viagra cost?

Viagra is a very expensive medicine. Without insurance coverage, the price for a single pill can range from around $30 to $75 for the brand-name version. Some brands even charge $90 per tablet. 

Comparatively, Sildenafil –  which contains the same active ingredient as Viagra – tends to be less expensive. It costs $10 to $40 per pill. You might also find cheaper versions that cost $3 to $8 per pill. 

Financial assistance for getting Viagra

Here are some options that can help offset the cost of Viagra:

1. Manufacturer Discounts

Some manufacturers may offer discounts on Viagra purchases. For example, this Viagra savings card (provided by Pfizer) helps save $350 per fill. However, you must not have any federal health insurance, so if you have Medicare, this option is not for you.

2. Pharmacy Coupons

Costco, Walmart, and Walgreens are a few examples of pharmacies that regularly have sales campaigns. You can get their coupons and purchase Viagra for reduced prices – especially when buying it in large quantities. 

3. Extra Help Program

The Extra Help program, also known as the Low-Income Subsidy (LIS), is a federal program designed to assist Medicare beneficiaries with limited income and resources. It helps cover prescription drug costs. So, you might get Viagra coverage.

4. Medicaid

Medicaid is similar to the Extra Help Program. It helps low-income individuals cover costs for healthcare services like doctor visits, hospital stays, prescription drugs, and more. So, if your Medicare Part C or D plan includes Viagra, Medicaid can help cover the cost. 

5. PACE

The Program of All-Inclusive Care for the Elderly (PACE) is for seniors aged 55 and older who qualify for nursing home care but prefer to live in their communities. PACE provides medical, social, and long-term care services to enrollees.

You can also receive coverage for prescription drugs like Viagra.

Conclusion 

All in all, it’s difficult to get Medicare Viagra coverage. Original Medicare doesn’t cover it because it is not medically necessary. So, most Part C and D plans do not include it in their plans either.

However, you may find some plans that cover it. You can also reduce the cost through manufacturer discounts, coupons, the Extra Help program, Medicaid, and PACE. If none of these methods work, it’s best to discuss the matter with your doctor and switch to generic Viagra.