Medical insurance can differ greatly from plan to plan. Some plans may offer coverage for ED medications like sildenafil (Viagra), but it is best to check with your insurer directly to confirm coverage and rules.
ED is one of the most common conditions in the United States. Many different treatment options are available, including prescription medications.
A doctor or healthcare professional may prescribe these medications. And some of them may be available through health insurance.
You can check this in several ways, but the easiest option is to contact your health insurance provider directly.
Health insurance coverage for ED medications
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Healthcare plans may offer coverage for ED meds. Yet multiple underlying conditions may contribute to ED, so a doctor or healthcare professional may want to investigate these causes to ensure you receive the best care.
Underlying ED causes may include:
hypertension or high blood pressure
type 2 diabetes
heart and blood vessel disease
an arterial disease, called atherosclerosis, caused by fatty deposits
chronic kidney disease
multiple sclerosis
Peyronie’s disease, which causes the penis to curve or bend due to the formation of scar tissue
If a doctor agrees that ED meds are appropriate for you, you can do any of the following to check whether you have drug coverage under your plan:
Check your coverage documents, including your benefits summary, which may include details of prescription drug coverage.
Speak with your insurer over the phone, making sure to have your policy information on hand. This could be on a welcome document or an insurance card.
Have a look at your insurer’s website to see details of the drugs covered under your plan
The reason ED coverage may differ between insurers could be due to their rules around medically necessary treatment. Different insurance companies have their own interpretation of the term “medically necessary” and may adjust their coverage accordingly.
In order for you to make a claim for ED medications, your health insurance plan must have coverage for prescription drugs. Most insurers will have a list of approved drugs available under their plans.
This list is often called a formulary, or simply a drug list. Formularies can include the least expensive version of a drug and have tiers relating to the medication costs — the higher the tier, the more you typically pay.
A 2020 research review looking at healthcare coverage for males with ED found that there are some disparities in coverage under plans, including employer-sponsored healthcare policies. The authors of the review call for a greater alignment in ED coverage and work toward removing systemic healthcare barriers.
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Medicare has different parts that provide different healthcare benefits:
Medicare Part A: This covers medically necessary inpatient treatment, including prescribed drugs and dressings as needed.
Medicare Part B: This covers outpatient treatment, including consultations and diagnostic tests. Part B also covers some prescription medications. These include medications that a healthcare professional must administer in their office, such as some shots and infusions.
Medicare Part D: This is available from private insurers and covers some prescription medications and some medical dressings.
Medicare Part C, or Medicare Advantage: These plans are available from private insurers and combine parts A and B benefits with some prescription drug coverage. They will also typically include optional benefits, like fitness memberships, optical coverage, or dental coverage.
If you have Part D coverage or Medicare Advantage, Medicare covers sildenafil, the generic version of Viagra. These plans may also cover generic versions of other ED medications, but it is best to confirm this with your plan provider.
What are the different prescribed ED medications?
Several different prescription drugs are available for ED. The first-line ED treatment is a class of drugs called phosphodiesterase-5 (PDE5) inhibitors. These drugs work by increasing cyclic guanosine monophosphate (cGMP) levels in the body to relax smooth muscles in the penis and increase blood flow.
This drug works by expanding blood vessels in the penis to aid blood flow and comes as an injection or suppository. Doctors and healthcare professionals typically recommend this medication only if ED does not respond well to first-line treatments.
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Some insurance plans provide cover for erectile dysfunction medication.
If a doctor or healthcare professional recommends prescription drugs for ED, before making a purchase you should consider checking with your insurer to see if your plan covers the medications. You can do this by checking your policy documents, calling your plan provider, or checking the website.
Prescription medications for ED include sildenafil (Viagra), tadalafil (Cialis), and avanafil (Stendra). Your plan may cover all or some of them. You may also need to consider any applicable copayments or coinsurance.
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