Brand-name ED drugs are expensive and rarely covered by Medicare plans. But the generic Sildenafil is much cheaper and is covered by many Part D plans. However, it can often be purchased for less money with online coupons. When relying on Medicare plans for ED drug coverage, be sure to check the specific plan formulary for availability and cost of the medications.
What is Erectile Dysfunction?
Erectile dysfunction is the inability to get and maintain an erection that’s firm enough for sexual intercourse. The most common symptoms of ED are:
- Difficulty getting an erection
- Difficulty maintaining an erection
- Reduced interest in sexual activity
ED may be a warning sign of more serious underlying medical conditions such as cardiovascular disease, so it is best to consult a doctor before obtaining Medicare ED drugs.
What are Erectile Dysfunction (ED) Drugs and How Do They Work?
Viagra and its generic (Sildenafil) is the most recognized brand of medication for treating erectile dysfunction. ED is a common condition affecting millions of men. More than 65 million prescriptions for the drug have been filled since it was first introduced in 1998. However, generally there is no Medicare drug coverage for ED treatment. Medicare guidelines for coverage do not consider these medications medically necessary.
How ED drugs work:
ED drugs are designed to enable the male penis to gain an erection when other factors such as medical conditions, medications, stress, and psychological disorders suppress the blood flow necessary to achieve and maintain an erection. When sexually aroused, the brain contacts the penis to release a chemical called cGMP, responsible for relaxing certain muscle cells necessary for penile erection.
However, the enzyme called PDE-5 works by breaking down the cGMP, thereby causing the penis to remain flaccid. The function of Viagra and other ED medications is to suppress the PDE-5 enzyme, allowing increased blood flow to the penis – enabling it to gain an erection when sexual stimulation is present.
Does Medicare Cover Viagra and Other Erectile Dysfunction Drugs?
- Original Medicare: Original Medicare is made up of hospitalization coverage Part A and medical coverage Part B. It does not cover outpatient medications and you must add a Part D drug plan for prescription coverage.
- Medicare Supplement Plans: Medicare Supplement (Medigap) Plans are offered by private insurance carriers approved by Medicare and include only what Original Medicare A and B cover. These plans help cover the copays, coinsurance, and some deductibles left over by Original Medicare coverage. Medicare Supplement Plans do not offer prescription drug coverage.
- Medicare Advantage Plans: Medicare Advantage Plans (Medicare Part C) are offered by private insurance carriers who have been approved by Medicare. Medicare Advantage Plans provide all your Part A and Part B benefits. In most cases, prescription drug coverage is also included. Although the plans usually do not cover Viagra and similar brand-name drugs, many plans cover the generic versions of these medications. Be sure and check the formulary (a plan’s list of covered drugs) of your Advantage plan to see what drugs it covers and at what costs.
- Medicare Part D Prescription Drug Plans (PDP): Medicare Prescription Plans, Medicare Part D, are available from private insurers approved by Medicare. These plans complement Original Medicare and Medicare Supplement Plans. PDP plans rarely cover brand-name ED medications, but many will cover the generic versions of these medications. Be sure and check the formulary of your PDP plan to see what drugs it covers and at what costs.
Which Parts of Medicare Cover Erectile Dysfunction Drugs?
The following table shows the coverage for ED medications offered by the various parts of Medicare.
| Medicare Plan | Coverage | Description |
| Original Medicare | No | Neither Part A nor Part B cover ED drugs |
| Medicare Advantage | Possibly | Some Advantage Plans cover generic ED drugs |
| Medigap | No | Medigap plans cover only what’s covered by Medicare Parts A and B, but ED drugs are not covered |
| Medicare Part D | Possibly | Some Part D plans will cover generic ED drugs |
Learn about enrollment and what Medicare Part D drug plans cover.
How Much Do Viagra and Other Erectile Dysfunction Drugs Cost on Medicare?
The cost of Viagra will depend on whether you are purchasing the brand name version or a generic version. Manufactured by Pfizer, the Viagra brand name drug is an expensive medication with costs typically varying between $15 to $50 per tablet. Cialis and Levitra, other common medications used in the treatment of ED, will have comparable prices. You can check for discounts and coupons offered by the manufacturer and other programs to lower the cost.
Always ask your doctor if they have free trial coupons offered by their drug manufacturer representatives for distribution to their patients. The drug manufacturer Pfizer has a Patient Assistance Program for some of its drugs, including Viagra. For those who qualify, some drugs are available for free in certain circumstances.
How much do generic erectile dysfunction drugs cost?
If you are purchasing the generic version, the most common is Sildenafil which costs a fraction of the brand name Viagra. However, most Medicare plans that cover Sildenafil have a copay that is above the cost you can find with online coupons.
For example, if you live in Phoenix, Arizona, you can use the GoodRx coupon to purchase Sildenafil from several local pharmacies for less than $10 for 30 pills. In most cases, this is less than the copayment you would owe if using your Medicare Part D or Medicare Advantage Plan coverage.
Learn More From Our Sources
- GoodRx | Viagra Medicare Coverage | Last accessed April 2024
- Medicare | Medicare Advantage Plans Cover All Medicare Services | Last accessed April 2024
- Medicare | What Medicare Part D Drug Plans Cover | Last accessed April 2024