Does insurance cover Cialis (tadalafil)?

If you’ve been prescribed Cialis — or are considering it — you might be wondering: Does insurance cover Cialis? The answer depends on your coverage and why the medication is prescribed. 

While some plans may cover the tadalafil (the generic version of the drug), many limit or exclude coverage when it’s used to treat erectile dysfunction (ED). Here, we’ll break down when Cialis may be covered, how much it costs with and without insurance, and ways to save if you’re paying out of pocket.

Insurance sometimes covers Cialis, but coverage varies and depends on your specific plan and why the medication is prescribed. 

Even though Cialis is approved by the US Food and Drug Administration (FDA) to treat erectile dysfunction, some plans don’t cover it. That’s because some insurers classify ED medications as “lifestyle drugs,” which means they may exclude them from coverage or place limits on how many pills you can get per month.

In fact, Medicare and Medicaid generally don’t cover Cialis or other ED medications. These drugs are often excluded from coverage under federal programs that limit benefits for medications considered non-essential or lifestyle-related.

Another factor: Even when coverage is available, insurers are often more likely to cover the generic version (tadalafil) rather than brand-name Cialis. The reason is that generics are significantly less expensive while offering the same active ingredient and effectiveness, making them the preferred option for insurers.

That said, Cialis may be more likely to be covered if it's prescribed for another medical condition. 

For example, both brand-name and generic versions of the drug are also FDA-approved to treat benign prostatic hyperplasia (BPH), a condition where an enlarged prostate can cause urinary issues. Insurers are often more willing to cover medications, including Cialis, for conditions like BPH because they’re considered medically necessary, rather than optional.

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Even though Cialis isn’t frequently covered by insurance when prescribed for ED, there are a few exceptions, including:

• When it’s prescribed for BPH: Some insurance plans are more likely to cover Cialis or tadalafil for conditions like BPH compared to ED.

• With a prior authorization: Some insurers require your healthcare provider to submit paperwork explaining why tadalafil is medically necessary. If the request is approved, the medication may be covered.

• When it’s considered medically necessary: In some cases, insurance may cover tadalafil if ED is linked to an underlying health condition (again, like BPH), and a provider documents that treatment is medically necessary.

• When other treatments haven’t worked: Some plans may approve coverage after you complete step therapy. That means you’ve tried other medications first (like sildenafil) without success, and your provider submits documentation to support switching to tadalafil.

The fastest way to find out whether Cialis or tadalafil is covered is to check your plan directly. Here are three simple ways to do it:

• Review your plan’s drug formulary: This is the list of medications your insurance covers. You can usually find it on your insurer’s website. Just search “[your insurance name] formulary” or log into your member portal. Look for “tadalafil” (the generic) and check what tier it’s on, any restrictions (like prior authorization), and whether it’s covered for your specific condition.

  • Note that tadalafil (Adcirca, Alyq) is also used to treat a lung condition called pulmonary arterial hypertension (PAH). Because PAH is a life-threatening disease that requires ongoing treatment, insurance plans are much more likely to cover the drug for this specific use. So, you may see tadalafil or sildenafil listed on a formulary — but not always for ED.

• Call your insurance provider: Call the number on the back of your insurance card and ask the representative if tadalafil is covered under your plan for ED or only for other conditions like BPH or PAH. You can also ask about copays, quantity limits, and whether prior authorization is required.

• Check with your pharmacy: If you already have a prescription, your pharmacist can often run it through your insurance and tell you the exact price in real time.

Medicare doesn’t typically cover Cialis when it’s prescribed for ED. 

Original Medicare (Part A and Part B) only covers limited prescription drugs for certain conditions, such as HIV, cancer, and kidney disease. And while Medicare Part D plans handle prescription coverage, many exclude ED medications like Cialis. That’s because federal rules generally don’t consider them medically necessary and thus won’t cover them.

In some cases, however, a Part D plan may cover generic tadalafil if it’s prescribed for another approved condition (like BPH). Because coverage varies by plan, the best way to find out whether tadalafil is covered is to check your specific Part D formulary.

Sometimes, but it depends on the state and why the medication is prescribed. Medicaid programs are run at the state level, so each state decides which drugs are covered. Many states do not cover Cialis when it’s prescribed for ED, since ED medications are often excluded from coverage. 

However, some Medicaid plans may cover tadalafil if it’s prescribed for another approved condition, such as BPH. Because coverage varies widely by state, the easiest way to check is to look up your state’s Medicaid drug list or ask your pharmacy.

The exact price of Cialis depends on factors such as dosage, the number of tablets, and where you fill the prescription. But in general, a month’s supply of brand-name Cialis can cost $444–$1,895 per month without insurance, and tadalafil can cost $42–$54 per month. 

Tadalafil is also available on Ro. Here’s a breakdown of the pricing:

If your insurance covers Cialis or generic tadalafil, you’ll typically pay a copay rather than the full price. That copay varies by drug, dosage, and your specific plan. 

Some plans also place limits on ED medications: For instance, it might only cover a certain number of pills per month, require prior authorization, or limit you to generic tadalafil. 

If your insurance doesn’t cover Cialis, you can still get the medication as long as you have a prescription from a licensed healthcare provider. Many people pay out of pocket through pharmacies or telehealth services.

Here’s how to get Cialis on Ro:

1. Complete an online visit: Answer a few questions about your health history and symptoms to be shared with Ro. 

2. Hear from a provider (typically within ~24 hours):  A licensed healthcare provider will review your information and evaluate which treatment is appropriate for you.

3. Get your prescription: If prescribed, your medication can be shipped directly to your door in discreet packaging.

4. Begin treatment: Ro-affiliated providers can adjust your treatment or answer questions if anything changes along the way — free, unlimited follow-ups are always available to members. 

If your insurance doesn’t cover Cialis, there are still a few ways to lower the cost. Here’s what to consider.

Switch to the generic

Generic tadalafil contains the same active ingredient as brand-name Cialis and works the same way in the body. The FDA requires generic medications to be as safe, of the same quality, and as effective as brand-name options. But because generics don’t carry the same brand costs, they’re usually much cheaper. 

Consider other drug formulations

Some telehealth providers offer alternative formats for ED medications. Ro, for example, offers the following compounded options containing tadalafil — the same drug in the FDA-approved pills: 

• Daily Rise Gummies are fruit-flavored gummies containing 7 mg of tadalafil, intended for daily use. Available as a monthly subscription, each gummy is less than $3 per day (or $89 per month) for one month, and under $2.50 per day (or $69 per month) for three months. 

• Ro Sparks is a fast-acting, sublingual (under-the-tongue) lozenge made with both sildenafil and tadalafil that starts to work in just 15 minutes (after dissolving). Each lozenge is $12 per dose on a monthly subscription plan (plans range from four to 10 doses of Sparks per month).

Because these options are manufactured in compounding pharmacies, they aren’t specifically FDA-approved for the treatment of ED (even though their active ingredients are). 

Use a savings program or pharmacy discount

Prescription discount programs and pharmacy coupons can sometimes reduce the cost of generic tadalafil. These programs aren’t insurance, but they can help lower the out-of-pocket price at participating pharmacies. Prices can vary widely between pharmacies, so comparing options may help you find the lowest price available.

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If insurance doesn’t cover Cialis for ED, these other treatment options (or a combination of them) can still help. 

Other prescription medications

Cialis is one of several prescription oral medications approved and commonly used to treat ED. These drugs belong to a class called phosphodiesterase type 5 (PDE5) inhibitors, which work by increasing blood flow to the penis during sexual stimulation. 

Research shows PDE5 inhibitors are effective for many people with ED. Other prescription options include:

• Viagra (sildenafil) 

• Vardenafil (formerly also available as Levitra)

• Stendra (avanafil) 

Lifestyle changes

Lifestyle factors can also play a role in erectile function. That’s why improving your overall health, but especially your vascular wellbeing (given its connection to ED), can support better blood flow and sexual function. 

While these changes won’t replace medical treatment when it’s needed, they’re known to support better erections:

• Exercise regularly

• Eat a nutritious diet (often focused on heart-healthy foods)

• Lose weight (if necessary) or maintain a healthy weight 

• Quit smoking and limit alcohol 

• Manage stress and mental health

• Get enough sleep

Vacuum erection devices (penis pumps)

Vacuum erection devices, or penis pumps, use suction to draw blood into the penis and create an erection. You then place a ring around the base of the penis to maintain the erection. 

These devices can be effective for people who cannot take ED medications or prefer a non-drug option. 

Injectable medications

For those who don’t respond to oral ED medications, healthcare providers may prescribe injectable medications such as alprostadil. These ED injections are administered directly into the side of the penis (often right before sexual activity) and work by increasing blood flow to the area. 

Common options include:

• Alprostadil injections (Caverject, Edex): at-home, self-administered injections (after initial in-office dose) that can last ~30–60 minutes. 

• Compounded injections (Trimix, Bimix, Quadmix): at-home, self-administered injections (after initial in-office dose) that can last ~30–60 minutes. 

• Non-standard injections (Priapus Shot or P-Shot): in-office, provider-administered injections have been shown to last up to six months in a clinical trial. 

Insurance coverage for Cialis can be a little unpredictable. Some plans cover tadalafil in certain situations, while others exclude erectile dysfunction medications entirely. Here’s what to keep in mind:

• Insurance sometimes covers Cialis (tadalafil), but coverage depends on your plan and why the medication is prescribed.

• Many insurance plans do not cover Cialis when it’s used to treat erectile dysfunction.

• Tadalafil may be more likely to be covered when prescribed for another condition, such as benign prostatic hyperplasia.

• Medicare and Medicaid usually don’t cover Cialis for ED, though coverage may vary depending on the plan or state program.

• If insurance doesn’t cover Cialis, switching to generic tadalafil or using savings programs may help lower the cost.