Medicare Coverage for Viagra, Cialis and Levitra
Medicare coverage for Viagra, Cialis, and Levitra, and other treatments for erectile dysfunction (ED) may be somewhat confusing. Hopefully, this article will help clear things up and make it easier to understand.
Men across the country consider trying expensive brand-name drugs to treat common erectile dysfunction disorder.
Millions of men suffer from symptoms of ED, and between 15-25% of these men are 65 and older. Meaning, this is a common concern for many beneficiaries.
As of 2016, Men with ED may have to come out of pocket up to $50 per pill for treatment.
Does Medicare Cover Viagra, Cialis, and Levitra
An underlying health condition usually causes the limiting of blood flow to the penis, causing ED. Things like stress, disease, and injury are common ED factors.
However, other leading causes also include diabetes, high blood pressure, and excessive alcohol consumption or drug use.
Treatment depends on the cause of erectile dysfunction. Currently, there are three main types of treatment for ED. Prescription drug coverage is not part of Medicare.
Beneficiaries must enroll in a separate drug plan, such as a Part D plan.
What is Viagra, Cialis, and Levitra
Prescription medications often given to patients to treat erectile dysfunction are meant to relieve the symptoms of ED causes. At the top of the list are the three most popular in the U.S., Viagra, Cialis, and Levitra.
Millions of men dealing with ED found relief using these medications. All options increase circulation and blood flow to the penis, in turn producing erections.
Although it’s important to remember, these are three different medications. While they all work similar, each has its benefits as well as cost.
Prices may vary; Viagra is the most expensive of the three.
Erectile Dysfunction Drug Costs
When choosing which pill is right for you, the price can play a significant role. Not all erectile dysfunction drugs are the same.
Ideally, you want a medication that works right for your body; what works for one person may not work for another.
Unfortunately, health insurance restrictions are usually the final determining factors. Many insurance plans place restrictions on the number of pills a patient may receive each month.
After reaching the limit amount, out-of-pocket costs for one tablet can be $20-$50.
Erectile dysfunction drug costs depend on the co-payment amount, health insurance coverage, plan type, and the pharmacy price. The national out-of-pocket cost per pill is generally $15 – $20.
Part D Plans that Cover Cialis
Sexual dysfunction drugs aren’t “medically necessary” by Medicare standards, which is why they don’t offer coverage for these drug costs.
There’s still hope as some Part D plans do cover costs of Cialis, depending on the dosage.
Part D plans may cover Cialis if for bladder outlet obstruction or signs of BPH. The patient’s diagnosis must be on the problem list before coverage begins.
The list of drugs a plan covers is known as the formulary. Each Part D plan has its formulary; beneficiaries should review this list to ensure proper coverage.
Medicare Part D Coverage for Generic Viagra, Cialis, and Levitra
Viagra is the most popular male sexual dysfunction drugs. The problem is, Medicare doesn’t pay for this brand-name medication.
On the other hand, coverage may be available for new generic versions of ED medications in some Part D plans.
In Viagra, the active ingredient is sildenafil, which may also treat pulmonary arterial hypertension.
Most Medicare plans provide coverage for the generic versions of ED drugs when used to treat health conditions other than erectile dysfunction.
Beneficiaries should check pharmacy coupons and cash prices often. Sometimes the cost is lower than using insurance.
The lowest price for generic Viagra on GoodRx is about $15 comparable to retail prices of $200+.
Levitra is another drug for treating ED, and the generic (Vardenafil) is now FDA-approved. Meaning, they have the same strength and quality as the brand-name version.
Patients seeking a less expensive option for Cialis may find the generic Tadalafil to be more affordable.
Medicare Advantage Plans that have Coverage for Viagra
A handful of Medicare Advantage plans offer coverage for drugs like Viagra. Beneficiaries with Medicare Advantage Part D plans have Advantage plans with prescription drug coverage.
Although even with insurance, it’s may still be expensive. However, costs and coverage may vary among plans.
Many factors contribute to this, such as service area, plan type, deductibles, copayments, and coinsurances.
Medicare and Medicaid Coverage for Viagra
The Centers for Medicare & Medicaid Services made a statement about Part D plans last spring. Allowing Part D plans the option to cover medications to treat painful intercourse due to menopause in women.
According to CMS officials, this isn’t a requirement, but the option for coverage is now available. Applauding the change, of course, was the North American Menopause Society.
Sexual health experts say this is like erectile dysfunction and men. Treatment for both may provide both emotional and physical relief.
Medicare and Medicaid coverage options may be available for generic versions of ED drugs. Some doctors say they don’t even write prescriptions for Viagra anymore.
“These generics are inexpensive solutions for men.” – A urogynecologist at Lenox Hill Hospital, Dr. Elizabeth Kavaler, stated.
Does Medicare Cover Penile Implant Surgery
Yes, Medicare and Medicare Advantage Plans offer coverage for penile implant surgeries. If it’s medically necessary, coverage includes all other Coloplast devices.
Healthcare providers should explain the criteria for patients.
Unless supplement insurance is in place, patients can expect to make payments of $2,500 – $3,000 for the procedure.
Generally, this is an outpatient service, so Part B covers 80% of the allowable costs. The beneficiary is responsible for the remaining 20%.
Part B also includes penile pumps and other devices like it.
CBD and ED
Anxiety is one of the leading causes of erectile dysfunction; recent studies show that CBD (cannabidiol) is promising for lessening anxiety.
CBD-rich oil may be beneficial for men seeking other treatment options without using prescription medications.
Some men may decide to treat their ED situationally rather than taking medications long-term. CBD may be an ideal option due to the potential short-term benefits.
Some reports claim that CBD makes having sex more enjoyable and less painful for both parties.
Medicare Supplements for Erectile Dysfunction Consultations
Medigap or Medicare Supplement Insurance may help cover some of the out-of-pocket expenses for sexual health/dysfunction treatments.
Starting with erectile dysfunction consultations to diagnose and adequately treat the individual.
If you’re looking for ways to cut costs at the doctor or want to learn more about Medigap, give one of our agents a call today.
Can’t call today? Fill out an online rate form and get the process started.
Our team of licensed agents specializes in all things Medicare.
We’re happy to compare rates and answer any questions you may have about coverage – free of charge.
View Comments (2)
Hello..I’m currently on Blue/Blue Shield till Dec.31. Then will be switching to either Medigap or Medicare Advantage. My urologist has prescribed both generic viagra and cialis also muse 1000mg. I do have high blood pressure and I’m on medication for that and also have enlarged prostrate and on medication for that also. My question is will theses meds be covered by unitedhealthcare plan f or a medicare advantage plan.
Hi Randy! Medigap Plans do not cover any prescription drugs. You would either need to get an Advantage plan or Medigap Plan + Part D plan. You can use the Medicare plan finder tool to type in your medications and see what Advantage & Part D Plans will cover them in your area.
