Key takeaways
- Insurance coverage for ED treatments can differ greatly depending on what plan you have.
- Certain insurance plans offer coverage for ED medications like sildenafil (Viagra), but it’s best to check with your insurer directly to confirm coverage.
- Medicare Part D or Medicare Advantage plans generally cover ED drugs like Viagra, but you should still consider checking your specific plan.
Overview
ED is a very common condition in the United States and worldwide. Many different treatment options are available, including prescription medications specifically to treat ED and those that target underlying conditions causing ED.
A doctor or healthcare professional may prescribe these medications, and some of them may be available through health insurance. You can check availability in several ways, but the easiest option is to contact your health insurance provider directly.
This Men’s Health Month, let’s take a look at coverage for ED medications.
Need a prescription or refill for ED medication? You can get discreet and expert on-demand care in as little as 15 minutes through Optum Perks. For $29, answer a few questions online and get a treatment plan from a US-licensed healthcare professional. Get started here.
Health insurance coverage for ED medications
Healthcare plans may offer coverage for ED-specific drugs like Viagra, although some insurance plans consider this a cosmetic or non-essential treatment.
However, several 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 and receive coverage.
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
Decreasing testosterone levels as a person ages may also contribute to ED.
How to check coverage for ED medications
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
ED coverage may differ between insurers due to their rules around medically necessary treatment. Different insurance companies may interpret the term “medically necessary” differently and 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 called a formulary, or simply a drug list. Formularies can include the least expensive version of a drug and have tiers related to 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 greater alignment in ED coverage and work toward removing systemic healthcare barriers.
Medicare coverage for ED medications
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.
They include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
- avanafil (Stendra)
Another option is alprostadil (Muse, Caverject). This is a second-line ED treatment, and there is currently no generic option available.
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.
If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.
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Get free cardOnline care for ED
If you think you have ED, it’s important to seek treatment. Many people avoid treatment due to embarrassment or shame around the condition, but there is nothing to feel ashamed about. This Men’s Health Month, consider seeking treatment for your condition.
Online care services, including Optum Perks Online Care, may make getting treatment easier. With these services, you can submit an online form answering a few questions about your symptoms, and a US-licensed healthcare professional will respond soon after to prescribe a treatment plan.
Summary
Some insurance plans provide coverage 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.
Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.