Does Medicare Cover Viagra?

Medicare Part A and Medicare Part B (Original Medicare) do not cover Viagra (sildenafil citrate) or most other prescription medications.

Medicare prescription drug benefits sold by private insurance companies can be obtained through a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan. Some of these private plans may offer coverage for erectile dysfunction drugs like Viagra or Cialis, though many do not.

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Medicare Part D and erectile dysfunction (ED) drugs

Whether you receive Medicare Part D drug coverage through a stand-alone prescription drug plan or a Medicare Advantage plan, your plan will have a formulary,1 or list of covered medications. Before enrolling in a plan, you should always review the formulary to make sure it provides coverage for the medications you take. A licensed insurance agent can help you with this.

Viagra — or the generic version (sildenafil) — may or may not be included in your Medicare Advantage plan or Part D prescription drug plan’s formulary, though, historically, these types of drugs have not been covered by Medicare Part D.

Both types of plans are offered by private insurance companies. Formularies can vary across plans and are subject to change.

If your plan does not offer coverage for Viagra, you may be eligible for savings on the drug through its manufacturer, Pfizer.

Medicare coverage for sexual dysfunction treatments

Though Medicare Part A and Part B don’t cover medications like Viagra, they may help provide coverage for other erectile dysfunction treatments.

The same is true for Medicare Advantage plans. ED can be caused by a number of other health issues, including, but not limited to:2

  • Obesity
  • Cardiovascular problems
    • High blood pressure
    • High cholesterol
    • Heart disease
    • Atherosclerosis
  • Smoking
  • Prostate problems, including cancer
  • Alcoholism
  • Certain prescription medications
  • Diabetes

Management and treatment of these conditions are usually considered “medically necessary” and are typically covered by Medicare Part A and Medicare Part B. Treating the root cause of your erectile dysfunction could help alleviate it.

If you receive treatment under Medicare Part B, you typically pay 20% of the cost of services after you meet your Medicare Part B deductible ($185 in 2019).

While Medicare Part A and Medicare Part B usually don’t cover most direct erectile dysfunction treatments, they may help cover penile implant surgery if a doctor deems it to be medically necessary.3

Find a Medicare Advantage plan that covers your needs

Are you eligible to enroll in Medicare? If you’re ready to learn more about Medicare Advantage plans available in your area, give one of our licensed insurance agents a call at TTY Users: 711 (24 hours a day, 7 days a week).

Learn more about your plan options and find the coverage that’s right for you.

 

Learn more about what Medicare covers

 

1 The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

2 Mayo Clinic. Erectile dysfunction. (March 9, 2018). Retrieved from www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776.

3 Span, Paula. 'Sex Never Dies,’ but a Medicare Option for Older Men Does.” (July 31, 2015). The New York Times. Retrieved from www.nytimes.com/2015/08/04/health/sex-never-dies-but-a-medicare-option-for-older-men-does.html.

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