Medicare does not cover Viagra or other erectile dysfunction drugs

Medicare Part B and Part D do not pay for Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), or Stendra (avanafil). These medications fall into a category that Medicare explicitly excludes: drugs used for sexual dysfunction. This exclusion has been in place since Medicare began, and it applies to all seniors with Original Medicare or Medicare Advantage plans, regardless of the reason a doctor prescribes the drug.

The exclusion is federal policy, not something individual plans can override. Even if you have a Medigap supplemental plan or a Medicare Advantage plan with generous drug coverage, that coverage does not extend to erectile dysfunction medications. You will pay the full pharmacy price out of your own pocket.

Key Takeaways

  • Medicare Part B and Part D explicitly exclude all erectile dysfunction medications, including Viagra, Cialis, Levitra, and Stendra.
  • This exclusion applies to everyone with Medicare, whether they have Original Medicare, Medicare Advantage, or a Medigap plan.
  • You can ask your doctor about lower-cost generic versions or discuss whether the medication is medically necessary for a condition like pulmonary hypertension, which Medicare may cover differently.
  • Some pharmaceutical manufacturers offer patient information programs that reduce the cost of these drugs for people with limited income.
  • GoodRx, SingleCare, and similar discount programs can lower the out-of-pocket price at the pharmacy, though they are not Medicare benefits.

Why Medicare excludes these drugs

Medicare's exclusion of erectile dysfunction medications is based on the definition of what Medicare will and will not pay for. Federal law states that Medicare cannot pay for drugs used to treat sexual dysfunction. This is a blanket rule that does not change based on medical need, age, or the underlying cause of the condition.

The policy reflects a long-standing decision that these medications are not medically necessary in the way that, for example, a heart medication or diabetes drug is. Even though erectile dysfunction can be a symptom of serious health conditions like heart disease or diabetes, Medicare treats the symptom itself as outside the scope of coverage.

What happens if the drug treats a different condition

There is one narrow exception: if a doctor prescribes sildenafil (the generic form of Viagra) to treat pulmonary hypertension or pulmonary arterial hypertension, Medicare may cover it under Part B as an injectable medication given in a medical setting. This is because the drug is being used to treat a serious lung condition, not erectile dysfunction.

If you have been prescribed sildenafil for pulmonary hypertension, ask your doctor whether the prescription is written for that indication. If it is, your Part B coverage may explore. However, if the same drug is prescribed for erectile dysfunction, even if you also have pulmonary hypertension, Medicare will not cover it.

Generic versions and lower costs

Sildenafil (Viagra's generic form) has been available since 2017 and is significantly cheaper than the brand-name drug. At many pharmacies, a month's supply of generic sildenafil costs between $15 and $40, compared to $200 or more for brand-name Viagra. Ask your doctor to prescribe the generic version if cost is a concern.

Tadalafil (Cialis) also has a generic version available. Vardenafil (Levitra) is available as a generic as well. Stendra (avanafil) remains brand-name only and is the most expensive option. Comparing prices across pharmacies using GoodRx or SingleCare can save you another 20 to 40 percent on the generic versions.

Discount programs and patient information

Discount pharmacy programs like GoodRx, SingleCare, and RxSaver are not Medicare benefits, but they can reduce what you pay at the pharmacy counter. These programs negotiate discounted rates with pharmacies and are free to use. You straightforward enter the medication and your zip code to see prices at nearby pharmacies, then present a coupon at checkout.

Some pharmaceutical manufacturers also run patient information programs for people with limited income. Pfizer (which makes Viagra) and other manufacturers may reduce or waive the cost of their drugs for seniors who meet income requirements. Ask your doctor's office to help you contact the manufacturer, or search the Partnership for Prescription information website for programs tied to specific drugs.

What to ask your doctor

If you have been prescribed an erectile dysfunction medication and are concerned about cost, have this conversation with your doctor:

  • Is there a generic version available, and can you prescribe that instead?
  • Is there a different medication that might help and that Medicare does cover?
  • If the medication is for a condition other than erectile dysfunction (such as pulmonary hypertension), is that indication documented in the prescription?
  • Are there any patient information programs through the manufacturer that I might be may be able to access for?
  • Are there non-medication approaches we should discuss first?

Your doctor may also refer you to a urologist or cardiologist who has experience helping patients find affordable options.

Frequently Asked Questions

Can a Medigap plan cover Viagra if Original Medicare does not?

No. Medigap plans are designed to cover what Original Medicare covers — they fill gaps in deductibles and coinsurance, but they cannot cover services or drugs that Medicare itself excludes. Since Medicare excludes erectile dysfunction drugs, Medigap plans do not cover them either.

Does Medicare Advantage cover erectile dysfunction drugs?

Medicare Advantage plans must cover everything that Original Medicare covers, but they cannot add coverage for things Medicare excludes. Some Advantage plans offer additional benefits like dental or vision, but none can override the federal exclusion of erectile dysfunction medications.

What if I cannot afford the out-of-pocket cost?

Start with the generic version of sildenafil, which is the least expensive option. Then use a discount program like GoodRx to compare pharmacy prices. Contact the drug manufacturer about patient information programs. If cost remains a barrier, talk to your doctor about whether there are other treatments or lifestyle changes that might help.

Is there any way to get Medicare to cover these drugs?

The federal exclusion is set by law, not by individual Medicare plans or regional offices. You cannot appeal a coverage denial for erectile dysfunction drugs because the exclusion is blanket policy. However, if the drug is prescribed for a different condition (like pulmonary hypertension), coverage may explore — discuss this with your doctor.

Do I need a prescription to use a discount program like GoodRx?

Yes, you need a valid prescription from your doctor. GoodRx and similar programs do not provide prescriptions — they only show you discounted prices at pharmacies. You present the coupon at the pharmacy along with your prescription, and you pay the discounted price out of pocket.