Sunday, May 22, 2022

Does Medicare Part D Cover Sildenafil

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Find A Medicare Advantage Plan That Covers Prescription Drugs

Does Medicare Cover Viagra?

Are you eligible to enroll in Medicare? You can compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

You can also give one of our licensed insurance agents a call to learn more about Medicare Advantage plans available in your area.

You may be able to enroll in a Medicare Advantage plan that includes prescription drug coverage.

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. . 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. . 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.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

Medicare Coverage For Viagra

Medicare Part D is tasked with providing discounted, affordable prescription drug coverage for seniors enrolled in Medicare Parts A and B. In Part D, the federal government funds private insurance companies that provide prescription drug coverage. As of right now, this program only covers a narrow range of prescription drugs, and coverage will be given to the following:

  • Original Medicare
  • Medicare Medical Savings Account Plans
  • Medicare Private-Fee-for-Service Plans

Given the long research and certification process required for most prescription drugs, the process to certify prescription medication covered under Medicare Part D means options are limited. Moreover, experimental medication will almost always be excluded from coverage.

With this in mind, the patient should understand that insurance plans will vary between carriers. This makes estimating exact prices difficult. At the present moment, the monthly average for premium prices is estimated to be $33.19. But that will vary based on variables like your age, your location, and which company is supplying you with your coverage.

In addition to this premium charge, some insurance providers will enforce a separate prescription deductible that doesnt contribute towards the payment of prescriptions. Youll have to pay that deductible first before your medical benefits will kick in and reduce your out-of-pocket costs.

Does Medicare Cover Revatio Or Sildenafil

While some Medicare plans may not cover Revatio, some Medicare Advantage plans and Medicare Part D plans may cover generic Sildenafil.

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans . Most Medicare Advantage beneficiaries are enrolled in MA-PDs.1
  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Sildenafil.

Find Medicare Advantage plans with drug coverage

Or call 1-800-557-6059TTY Users: 711 24/7 to speak with a licensed insurance agent.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

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Medicare Part D And Erectile Dysfunction 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 may or may not be included in your Medicare Advantage plan or Part D prescription drug plans 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.

What Are The Side Effects Of Viagra

Does Medicare Cover Viagra

While Viagra is known to be highly effective in treating ED, it may also come with possible side effects that include:

  • Nausea or headaches
  • Body aches
  • Redness or flushing of the face or body

More serious side effects may include vision or hearing loss, confusion, shortness of breath, fainting or chest pain. Call a doctor if you experience any such symptoms.

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What Is Erectile Dysfunction

Men with erectile dysfunction may have problems getting an erection, or they may be unable to keep an erection long enough to enjoy sex. Some men with ED can occasionally get an erection while others have lost the ability altogether. In the past, ED was also called impotence, but that term is less common now.

There are many causes of ED, and the condition can sometimes indicate a more serious health problem. Speaking with a doctor can help determine the cause of ED, which can include:

  • Diabetes
  • Medications, including blood pressure medications and antidepressants
  • Depression and other psychological causes
  • Alcohol or drug use

Although ED is more common in older men, it can occur at any age and isn’t necessarily a part of normal aging.

What Erectile Dysfunction Drugs Are Covered By Medicare

Home / FAQs / Medicare Coverage / What Erectile Dysfunction Drugs are Covered by Medicare

Medicare coverage for erectile dysfunction prescriptions may have coverage under Part D. Most brand name medications for erectile dysfunction, such as Viagra, Cialis, and Levitra, are not covered under Part D. However, the generic versions have some coverage. Some Medicare Advantage plans that include prescription drug coverage cover the brand name medications for erectile dysfunction. Well cover this in detail below.

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Is Viagra Covered By Insurance

First things first, you should check with your insurance company to see whether they cover Viagra or other ED drugs. If they do, problem solved. But even if they dont, your specific insurance plan might provide coverage for comparable medications, like generic versions. So, which drugs might be covered?

If your health plan covers any of these name brand or generic drugs, you most likely will still have a copayment, but the amount depends on your specific plan. When you discuss coverage with your insurance provider, be sure to ask how much your copay will cost.

Consult your primary care physician or urologist when evaluating ED drugs, as the best drug for you largely depends on your health history, lifestyle, and other current medications.

Does Medicare Part D Cover Viagra

Medicare Part D

Medicare Part D is also offered by private insurance companies with plans approved by Medicare. You must be enrolled in original Medicare to be eligible to enroll in a Part D plan. Costs and types of coverage vary based on where you live. There are typically hundreds of plans to choose from in any given state.

Choosing a Part D plan

ED medications are not generally covered by Medicare Part D plans, but Revatio is covered by most plans. You can go to Medicare.govs Find a Medicare Plan tool to compare rates and drug coverage before choosing a plan.

Each plan has a formulary that lists the specific drugs that it covers. Check to see if Viagra or a generic ED medication is listed as covered. You can also call the plans provider and ask if Viagra is covered.

Medigap is an add-on coverage plan to help pay for coinsurance, deductibles, and copayment expenses not covered by original Medicare. There are 10 plans to choose from that offer different levels of coverage.

Medigapplans do not pay for prescription medications. Viagra would not be coveredunder any Medigap plan.

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Does Original Medicare Cover Viagra

Medicare has four different parts and each covers prescription medications differently. Parts A and B are also referred to as original Medicare. Medicare Part A covers costs related to inpatient hospital stays, hospice, skilled nursing, and home healthcare. Part A does not cover Viagra or other ED medications.

Medicare Part B covers outpatient doctor visits, preventive screenings, counseling, and some vaccines and injectable medications given by a healthcare professional. Viagra and other medications for ED are not covered under this plan.

Low Income Subsidy Questions

  • I have both Medicare and full Medicaid coverage. Do I need to apply for extra help to pay for Medicare prescription drug coverage?

    No. The “extra help” is a subsidy that people with Medicare and Medicaid automatically qualify for without having to complete an application.

  • If I am enrolled in a Medicare Savings Program, do I have to apply for “extra help”?

    If you do not have Medicaid, but Medicaid pays your Medicare Part B premium, you automatically qualify for “extra help” and you don’t need to apply.

  • If I do not qualify for NYS Medicaid or the Medicare Savings Program, can I still qualify for “extra help”?

    You may still be eligible for “extra help” to pay for the Medicare prescription drug plan premiums. To apply for extra help, you should visit or call your local Social Security Administration office or apply on line at

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    Medicare Coverage For Erectile Dysfunction

    • Read about diagnostics and treatments for erectile dysfunction, and learn which services are covered by Medicare. Get tips for finding affordable medications.

    Erectile dysfunction affects around 30 million men in the United States and is especially prevalent among older men. While there are effective treatments available for the condition, Medicare coverage for erectile dysfunction is limited.

    Ask Your Doctor For A Larger Quantity

    Is Viagra Covered by Medicare?

    Theres a reason that companies like Costco can offer such great deals. Buying in bulk almost always lowers the cost per unit, and this applies to drug costs, too. Purchasing 10 pills at once will likely yield a lower price per pill than buying one at a time. Even if insurance or Medicare Part D does cover your medications, bigger prescriptions can still save you money. Each time you fill a script, you owe a copay. Your deductible and prescribed dosage determines your copay. If you dont need to refill quite as often, youll end up having fewer copays. Consult your doctor about changing your current prescription.

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    Does Original Medicare Pay For Drugs Like Viagra

    Medicare Part A provides some coverage of medications when theyre used in an inpatient hospital or skilled nursing setting or as part of hospice or home health care. But Medicare Part A does not typically cover medications that you would pick up at a retail pharmacy such as Viagra or other erectile dysfunction drugs.

    Medicare Part B covers some medications that have to be administered by a health care professional in an outpatient setting, such as certain types of injections. But like Part A, Medicare Part B does typically cover any medications prescribed by a doctor that are then picked up at a pharmacy.

    Medicare Advantage and Medicare Part D plans are different from Original Medicare because they’re sold by private insurance companies and are able to offer some additional benefits not found in Original Medicare.

    Medicare Part D plans specifically cover prescription drugs. Medicare Advantage plans often include prescription drug coverage along with other benefits like dental, vision, hearing and more.

    How Much Will Birth Control Cost If I Have Medicare

    Medicare Advantage and Medicare Part D prescription drug plans are offered by private insurance companies. Their costs vary according to the plan you choose and the coverage it provides.

    The chart below contains some examples of common birth control medications and devices, and what your costs may be after youve met your annual deductible and paid the plan premium.

    Birth control method

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    What Medicare Part D Drug Plans Cover

    All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, like drugs to treat cancer or HIV/AIDS. A plans list of covered drugs is called a formulary, and each plan has its own formulary. Many plans place drugs into different levels, called tiers, on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.

    Does Medicare Part C Cover Viagra

    Medicare Prescription Drug Coverage

    Medicare Part C, or Medicare Advantage, is a private insurance option that offers all the benefits of parts A and B. Medicare Part C also covers prescription drug benefits and other extras like dental, vision, and fitness memberships. There are HMO, PPO, PFFS, and other types of plan options available.

    Although Part C plans offer extra benefits, there may be restrictions on in-network doctors and pharmacies.

    Typically, Part C plans with prescription drug coverage do not cover Viagra or similar medications for ED. Some plans may cover generic versions. Check your specific plan to see which drugs are covered.

    You can also try to appeal a coverage decision. Your doctor would need to write a letter to your insurance company explaining why the medication is medically necessary.

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    Which Drugs Similar To Viagra May Be Covered By Medicare

    Viagra is a brand name version of the generic drug sildenafil. Sildenafil can be used to treat erectile dysfunction but may also be used to treat other conditions. Many Medicare Advantage or Medicare Part D plans may cover generic sildenafil.

    Revatio, another brand name version of sildenafil, may be covered by Medicare Advantage or Medicare Part D when prescribed for treatment of pulmonary arterial hypertension.

    Is There A Way To Get More Affordable Treatment For Ed

    Treatments like Viagra, Cialis and penis pumps can be expensive without insurance coverage. Because there is little Medicare coverage for erectile dysfunction treatment, beneficiaries may look for other ways to afford doctor-prescribed ED medication. Some options include:

    • Paying out of pocket for generic versions of medications, which are often significantly cheaper than the brand name drug
    • Using pharmacy discount programs or coupons
    • Purchasing medications from a reputable mail-order pharmacy

    A doctor can also recommend a vacuum erection system, but the Medicare beneficiary will have to pay for the device’s total cost out of pocket.

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    Average Costs For Sildenafil With Medicare Drug Coverage

    Your copay and deductible costs for any prescription drug can vary depending on what coverage stage youre in and the Medicare drug plan you have.

    Deductible stageTypical copay stage
    Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.In the deductible stage, youre responsible for the full cost of your prescription drugs.Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $480 in 2022.After you meet your Part D deductible, you enter the initial coverage period.During this phase , you pay a copayment or coinsurance for your covered medications.

    Medicare Paid Millions For Viagra

    Does Medicare Cover Viagra?

    WASHINGTON — Despite a rule that bars Medicare reimbursement for erectile dysfunction treatments, the Centers for Medicare and Medicaid Services paid out $3.1 million for the drugs in 2007 and 2008, a new government report found.

    Of the $3.1 million, $3 million went toward paying for Viagra, according to the report prepared by the Department of Health and Human Services Office of the Inspector General.

    The congressional ban went into effect in 2007.

    “… Part D should not have covered these drugs,” concluded the report.

    Other FDA-approved drugs to treat ED include tadalafil , vardenafil , and alprostadil injections and suppositories , but those prescriptions accounted for just a fraction of the total cost CMS spent on treating ED in 2007 and 2008.

    The Medicare Modernization Act of 2007 stated that CMS wouldn’t pay for “… a drug when used for the treatment of sexual or erectile dysfunction, unless such drug were used to treat a condition, other than sexual or erectile dysfunction, for which the drug has been approved by the Food and Drug Administration.”

    CMS will still pay for ED drugs to treat other conditions for which they are FDA-approved, such as pulmonary hypertension.

    The ED prescriptions were erroneously paid for because CMS’ Medicare Drug Data Processing System didn’t have an updated list of excluded drugs, so it automatically approved the reimbursements for ED drugs prescribed for sexual or erectile dysfunction, the report said.

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    Are There Other Potential Options Beyond Medicare

    In the case that an individual isnt able to afford or have their Viagra supplements covered due to expenses, there are alternative ways of mitigating the issue. For instance, options such as:

  • Lifestyle Changes any lifestyle changes you can make that promote better health could alleviate your symptoms so that you dont need Viagra anymore.
  • Treatment for Underlying Conditions If you suffer from health conditions that are known to contribute to erectile dysfunction , touch base with your doctor and come up with a comprehensive treatment plan to alleviate symptoms for better health.
  • Coupons & Discounts Depending on the drug manufacturer, certain companies like Pfizer offer discounts on as many as 12 of their Viagra supplements per year. Besides this, Pfizer also provides an assistance program for certain drug purchases.
  • State Pharmaceutical Assistance Program Throughout the United States, some state programs offer assistance to their residents by paying for their medications.
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