Is Viagra covered by insurance?
Viagra and other similar drugs for treating erectile dysfunction, like Cialis or Levitra, are expensive medications. Here’s some guidance on how to find out if your health insurance plan covers any of these medications (or their generic counterparts) and what you can expect if you’re paying with cash.
Written by Rachel Honeyman
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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you’re looking to try Viagra to treat your erectile dysfunction (ED), you might be surprised by what a big dent this little blue pill can make in your wallet. Considering ED is a medical condition with far-reaching impacts on your health and quality of life, you might think it’s a given that Viagra (and other erectile dysfunction drugs that work in a similar way) would be covered by insurance. Unfortunately, that’s not always the case.
The good news is, even if your insurer does not cover Viagra, there are more affordable options available.
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Will my insurance cover Viagra?
As with any medication, treatment, or diagnostic test, every health insurance plan has different policies about what they will and won’t cover. Many insurance companies have a listing of drugs they’ll cover under different plans available on their websites.
For instance, some large group plans under Blue Cross Blue Shield appear to cover a portion of the cost of Viagra, as well as other phosphodiesterase-5 (PDE5) inhibitors (the drug class Viagra is a part of), such as Cialis and Levitra (Blue Cross Blue Shield, 2021). Cigna also seems to cover these medications under some of their plans (Cigna, 2021).
No matter what insurance plan you have, it’s important to call your insurance provider to verify which medications they’ll cover and under what circumstances. They may have certain requirements for prior authorization (where someone from the insurance company will need to review the prescription from your healthcare provider before authorizing coverage). Or, they might limit how much you can get at once and how many refills are available. You’ll also need to find out about any copayments.
Viagra is not the only medication available to treat erectile dysfunction. When you call your insurance provider for verification, be sure to also ask about insurance coverage for any of the following medications as well (if Viagra isn’t covered):
- Sildenafil citrate (this is the active ingredient in Viagra; see Important Safety Information)
- Cialis (or its generic counterpart, tadalafil; see Important Safety Information)
- Levitra (vardenafil)
- Stendra (avanafil)
If your insurance provider covers certain medications but not others, speak with your healthcare provider to see if switching to a covered medication makes sense for you. Your insurance provider may also offer different coverage for different dosages or uses. For example, Cialis is available in two ways: as-needed (2.5 mg, 5 mg, 10 mg, or 20 mg) or daily (2.5 mg and 5 mg) (Brock, 2016). Your insurance may cover one but not the other.
If your insurance does cover any of these medications, you may still need to pay a copay, or coverage may only go into effect after meeting your deductible. Every plan is different.
What does Viagra cost out-of-pocket?
If your insurance plan does not cover Viagra, the out-of-pocket drug costs can be quite high. It can cost up to $2,000 for 30 pills of a 100 mg dose (GoodRx-a). Every pharmacy offers its own rates, though, so it’s worth shopping around.
The cash price for Cialis varies widely based on the dosage. For the lowest dose (2.5 mg), Cialis generally costs around $350 for 30 pills, while the highest dose (20 mg) can cost over $2,000 (GoodRx-b).
The average retail price for Levitra is around $1,700 across all dosages for 30 pills (GoodRx-c).
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Finally, Stendra, which is a less commonly prescribed medication for ED, costs around $1,600 out-of-pocket (GoodRx-d).
Don’t feel too discouraged by those steep prices, though! There are more affordable options available.
Cheaper alternatives to Viagra, Cialis, and Levitra
While there isn’t currently a generic version of Stendra available (it’s still under patent, so only the brand name is available for now), there are cheaper versions of the other three PDE5 inhibitors on the market.
Cheaper alternatives to Viagra
There are two cheaper versions of sildenafil citrate (the active ingredient in Viagra) available: generic Viagra and generic Revatio (see Important Safety Information).
Generic Viagra is similar to Viagra and comes in the same doses.
Revatio is a medication that’s FDA-approved for treating a specific type of high blood pressure in the lungs (Croom, 2008).
It may seem confusing, but Revatio has the same active ingredient as Viagra. The difference is that it comes in different strengths. While Viagra comes in 25 mg, 50 mg, and 100 mg tablets, Revatio comes in 20 mg tablets. Some healthcare providers prescribe generic Revatio at doses of 20 mg, 40 mg, 60 mg, 80 mg, or 100 mg to treat ED. However, this is considered off-label prescribing since Revatio, and its generic form are not specifically FDA-approved for ED.
Generic Revatio is a much more affordable alternative to Viagra, available for as low as $10 for 30 doses of 100 mg (depending on the pharmacy) (GoodRx-e).
Cheaper alternatives to Cialis
The active ingredient in Cialis is tadalafil, which is a longer-acting medication than sildenafil citrate (that means it lasts longer in the body), but it’s about equally effective (Gong, 2017). You can get tadalafil for around $20 for 30 doses (with some minimal variation with different doses) (GoodRx-f). And, of course, it depends on which pharmacy you use.
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Cheaper alternatives to Levitra
Levitra is the brand name for vardenafil, which is another PDE5 inhibitor that treats ED in a similar way to sildenafil citrate and tadalafil (Morales, 2009). Vardenafil is quite a bit cheaper than brand name Levitra but is still relatively pricey, costing close to $250 on average for 30 doses (GoodRx-c).
Is Viagra covered by Medicare or Medicaid?
If you’re on a Medicare or Medicaid plan, you will need to look into your specific plan benefits to find out about prescription drug coverage. In general, there’s a better chance of one of the generic versions—sildenafil citrate, tadalafil, or vardenafil—being covered under your Medicaid or Medicare plan than their brand name counterparts. Medicare part D plans are for prescription drug coverage.
How do PDE5 inhibitors treat erectile dysfunction?
Viagra, Cialis, Levitra, and their generic counterparts are all examples of PDE5 inhibitors, medications that treat sexual dysfunction in men. PDE5 inhibitors block an enzyme called PDE5. This enzyme, when not blocked, breaks down cyclic guanosine monophosphate (cGMP), which is a chemical that causes the blood vessels in the penis to relax. When PDE5 is blocked (with PDE5 inhibitors), cGMP levels increase, causing better blood flow to the penis. Better blood flow to the penis makes for stronger erections (Huang, 2013).
Make the right choice for your budget
All of these medications work in similar ways, with some differences in how long they last in the body and side effects. Ultimately, the medication you choose will depend on your healthcare professional’s medical advice, as well as what will fit best in your budget. Call your insurance provider to find out if any of these medications are covered under your plan. If they’re not covered, shop around for the most affordable options offered by different licensed pharmacies.
Will Your Health Insurance Plan Cover Medical Marijuana And CBD Oil?
Health studies and research has shown the multiple benefits marijuana and CBD oil can have when used for medicinal purposes, but the question still remains, will you health insurance cover either?
Updated: April 30, 2020
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Debates have gone on for years about the use of marijuana in medical treatments. Some states have gotten on board with approving marijuana for recreational use, medical use, or both. However, having it actually be covered by the various health insurance plans offered throughout the nation remains a topic of discussion, support, and controversy.
About Your Health Insurance Plan and General Coverage
Much of what your health insurance plan covers depends on the plan itself. Concerning medications, it is up to you to find out which ones are covered under the plan that you have. Typically, once enrolled in a plan, they send out additional information, including both brand-name and generic medications that are covered.
Before we dive into how health insurance plans handle medical marijuana, let’s touch on exactly what it is. To put the definition simply, medical marijuana is marijuana that is used in the treatment of certain ailments or as a means to alleviate symptoms from injuries or diseases.
There has been research done in an effort to prove the benefits and possible side-effects of this form of treatment, but not enough in the eyes of some. Even so, medical marijuana has grown in popularity, especially in children with life-altering or terminal illnesses. However, that has not ended any controversy surrounding the medicinal uses of marijuana.
Cannabidiol (CBD) is a natural compound found in the cannabis plant. It works alongside the other compounds (cannabinoids), one of which is the most recognized out of the bunch: delta-9 tetrahydrocannabinol (THC).
However, unlike with THC, CBD is the most non-psychoactive compound marijuana has. In other words, it does not alter your mindset or give you the “high” that THC does. It is one of the reasons why CBD is more attractive in terms of medical use.
One thing that might confuse individuals is that most of the CBD oil found for medical use is extracted not from marijuana, but from hemp. Although marijuana and hemp hail from the same cannabis sativa plant, the two are different; hemp usually lacks the modification seen in marijuana plants.
When it comes to CBD oil, several studies have proven the benefits of its use in medical treatments. For example, it can affect pain as well as inflammation. The health benefits, coupled with its lack of psychoactive abilities, is why some states have come around to approve of CBD oil even if they do not approve of recreational marijuana or medical marijuana.
Use and Coverage of Medical Marijuana
With some of the states across the nation coming around to approving the use of CBD oil or medical cannabis, the fight for legality in general wages on. Many states have tried to pull off legislation concerning the issue. In 2017, over a dozen states had ballot measures focusing on it.
Whether states approve it or not, a primary concern those who are looking into or are already receiving a form of medical cannabis treatment have is paying for it. Health insurance can get expensive in its own right.
As of now, medical marijuana itself is not covered by health insurances. This is due to the fact that cannabis is still classified at the federal level as a Schedule 1 controlled substance. Anything that is Schedule 1 cannot be legally prescribed. As such, in spite of several states approving the use of cannabis in medical treatments, patients have to pay for it out-of-pocket.
Additionally, health insurance companies look for clinically researched drugs when determining what to cover. In spite of the various studies and personal anecdotes about the benefits of medical cannabis, there is still a lack of firm clinical reports.
Though low-income patients may suffer from this lack of coverage the most, there are a number of prescription drugs that the FDA has approved that contain ingredients derived from marijuana. Not every drug is approved for use in the United States, but a couple has that can be covered by health insurance companies considering they have been approved by the FDA.