Does Medicare Cover Viagra?

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This article was updated on May 20, 2021. 

According to a study from the Cleveland Clinic, about 40 percent of men over age 40 experience erectile dysfunction (ED), and that number only increases with age. Common courses of treatment are drugs that treat ED like Viagra, Cialis, and Levitra. Does Medicare cover them?

Does Medicare cover Viagra?

Original Medicare does not cover most prescription drugs, unless they are administered in a hospital (Part A) or under a doctor’s supervision (Part B). Like most prescription drugs, Viagra is not covered by Original Medicare. 

To have coverage for prescription drugs that are picked up at the pharmacy, you’ll need a Medicare Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage. 

Many Medicare drug plans do not cover ED drugs as they are not considered to be medically necessary. However, as both Medicare Part D and Medicare Advantage plans with drug coverage are sold by private insurers, coverage and costs vary by plan. To check if your specific plan covers Viagra or other ED drugs, refer to your plan’s formulary, or list of covered drugs. 

The generic sildenafil may be covered by drug plans more often than brand-name Viagra, so check your plan’s formulary before asking your doctor for a prescription. 

Medicare Part B may cover durable medical equipment (DME) like pumps to help with ED. Medicare will cover 80 percent, and you will need to pay the remaining 20 percent. The Part B deductible applies.

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How do I pay for my ED drugs?

Viagra is the most expensive ED drug on the market, running about $20 – $50 per pill, but generic versions are often much cheaper. 

If your plan does not cover ED medications, see if your pharmacy or doctor’s office has coupons available. You can also ask for the cash price at the pharmacy, which may be lower than if you file with your insurance. You can also use drug discount websites like Medicare Plus Card or contact Pfizer, Viagra’s manufacturer, to see if you’re eligible for manufacturer discounts. 

Causes of ED

Erectile dysfunction is often caused by underlying health conditions. The top three health conditions that cause ED are:

  1. Vascular disease. Nearly 70 percent of ED cases are caused by some type of vascular disease, including atherosclerosis (hardening of arteries), high cholesterol, and high blood pressure. 
  2. Diabetes. High blood sugar damages blood vessels and decreases blood circulation, causing 30 percent of ED cases. 
  3. Kidney disease. Kidney damage can also cause decreased circulation and irregular hormones, also contributing to ED. 

Other conditions that can cause ED are:

  • Obesity
  • Heart disease
  • Mental health disorders like anxiety and depression
  • Smoking
  • Problems with the prostate (including cancer)
  • Alcoholism
  • Certain prescription medications
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