Does Medicare cover Viagra?

Does Medicare cover Viagra? Generally, no. Medicare Part D excludes medications prescribed for erectile dysfunction (ED), so Viagra (sildenafil) is typically not covered. Whether Viagra is covered by insurance outside Medicare varies by plan, and generic sildenafil is often available at a lower cash price.

Medicare Part D does not cover Viagra. Part D may cover generic sildenafil only when it is prescribed for a condition other than ED, such as pulmonary arterial hypertension (PAH).

Medicare generally does not cover Viagra, but coverage may vary by plan.

Medicare has four parts: A, B, C, and D. Each covers a different type of healthcare or bundles them together:

• Medicare Part A is known as Medicare’s “hospital insurance.” It helps cover inpatient care, hospice, and home health care.

• Medicare Part B covers medical services, such as outpatient care and preventive services (including screenings, vaccines, and flu shots), as well as durable medical equipment, such as wheelchairs and hospital beds.

• Medicare Part C, also called Medicare Advantage, is private insurance that bundles Part A, Part B, and, in many cases, Part D.

• Medicare Part D is Medicare’s optional prescription medication coverage. It covers a variety of prescription medications taken at home.

 When you sign up for Medicare, you must choose between two pathways:

1. Original Medicare (Parts A and B), which can be paired with a separate Part D plan

2. Medicare Advantage (private insurance that includes Parts A and B and, in many cases, Part D)

Regardless of which pathway you choose, Medicare generally does not cover medications prescribed solely for sexual or erectile dysfunction — and brand-name Viagra is approved by the US Food and Drug Administration (FDA) only to treat ED. However, people diagnosed with PAH, a type of high blood pressure in the lungs, may be able to get generic sildenafil covered under Part D.

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Does Original Medicare (Parts A and B) cover Viagra?

No, Original Medicare does not cover Viagra.

Original Medicare is a bundle of Medicare Part A and Medicare Part B.

Part A covers hospital care, and Part B covers medical services, equipment, and preventive services such as vaccines. Original Medicare does not include prescription medication coverage, so neither part typically covers medications taken at home, such as Viagra.

Does Medicare Part C (Medicare Advantage) cover Viagra?

Probably not, but it depends on your plan.

Medicare Advantage (Part C) is private insurance that includes the benefits of Part A, Part B, and, in many cases, Part D. None of those parts cover Viagra. However, some Medicare Advantage plans also offer additional benefits, such as vision, hearing, and dental coverage. Because extra benefits differ by plan, the plan itself can confirm whether any of them extend to ED medications.

Each Medicare Advantage plan is different. Reviewing a plan’s drug formulary (the list of covered medications) and benefits documents, or calling the plan, can confirm whether Viagra is included and, if so, what requirements apply.

Does Medicare Part D (Medicare drug coverage) cover Viagra?

No, Medicare Part D (Medicare drug coverage) does not cover Viagra. However, Part D may cover generic sildenafil when it is prescribed for pulmonary arterial hypertension (PAH), not for ED.

Part D categorically excludes medications prescribed to treat sexual or erectile dysfunction, so Part D plans do not cover Viagra.

Part D may cover sildenafil when it is prescribed for PAH. In this case, the medication is generic sildenafil 20 mg, the strength approved for PAH under the brand name Revatio. It contains the same active ingredient as Viagra but has a different FDA-approved use. Unlike ED, PAH is a “medically accepted indication” for Part D coverage, and Part D does not cover sildenafil prescribed off-label for ED.

People enrolled in Medicare Part D who have PAH can contact their plan to check whether it covers sildenafil for PAH.

Does Medigap (Medicare Supplement Insurance) cover Viagra?

No, Medigap does not cover Viagra.

Medigap is add-on coverage for people with Original Medicare (Parts A and B). Its purpose is to help reduce out-of-pocket costs, such as co-pays, coinsurance, and deductibles. Medigap plans sold after 2005 do not include prescription medication coverage, so Medigap does not cover Viagra.

Not exactly. Medicare Part D may cover sildenafil when it is prescribed for PAH, not when it is prescribed for ED.

Sildenafil is the active ingredient in two brand-name medications approved by the FDA: Viagra for ED and Revatio for PAH. Medicare Part D does not cover sildenafil prescribed for ED, but it may cover sildenafil prescribed for PAH, depending on the plan.

Medicare Part D may cover sildenafil only when a healthcare provider prescribes it for PAH, not ED.

The Part D exclusion for ED medications applies to every Part D plan, but formularies and plan rules for other uses differ. To check a specific plan:

• Review the plan’s drug formulary (the list of covered medications) for sildenafil 20 mg tablets, the strength approved for PAH.

• Call the number on the plan member ID card to ask whether sildenafil is covered for PAH and whether any requirements apply.

• Compare plans available in an area with Medicare Plan Finder.

The cash price of Viagra can exceed $100 per pill at retail pharmacies. Free samples of Viagra are no longer available.

The final price depends on the dose, pharmacy, and whether coupons or manufacturer discounts apply. Because Medicare does not cover Viagra, the cash price is the same with or without Medicare enrollment. On Ro, brand-name Viagra is available from $90 per dose with a valid prescription.

Generic Viagra (sildenafil) is typically much less expensive. Costs still vary by dose strength, pharmacy, and whether coupons or discounts apply. On Ro, sildenafil is available for as little as $4 per dose (with a valid prescription and billed as an eight-dose minimum of $32 per month).

Medicare does not cover any medication prescribed solely for ED. Part D, Medicare’s prescription medication coverage, explicitly excludes coverage of medications prescribed for sexual or erectile dysfunction.

Oral medications

Medicare does not cover pills prescribed to treat ED. That means these common oral medications are not covered when prescribed for ED:

• Viagra (sildenafil)

• Stendra (avanafil)

• Cialis (tadalafil)

However, Medicare may cover prescription medications taken to treat some of the underlying causes of ED, such as heart disease, high cholesterol, low testosterone, or atherosclerosis (clogged arteries).

Other treatments 

Medicare may cover the diagnosis and treatment of ED in some cases, including treatments other than medications. Coverage may depend on the underlying cause of ED, other health conditions, and whether the service is medically necessary.

For instance:

• Medicare may cover testosterone therapy (TRT) when it is deemed medically necessary.

• Medicare Part B may cover diagnostic tests to pinpoint the cause of ED and outpatient surgeries, such as penile implants, when they are medically necessary.

• Medicare Advantage plans vary by policy, so the plan itself is the best source for questions about other ED treatments, such as injections.

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Medicare coverage depends on why a medication is prescribed, not on which medication it is. Part D does not cover any medication prescribed for ED, including Viagra, but it may cover the same active ingredient when it is prescribed for an approved use, such as sildenafil for PAH or tadalafil for benign prostatic hyperplasia (BPH). For people paying the cash price, generic sildenafil is typically much less expensive than brand-name Viagra.

For people enrolled in Medicare who are interested in Viagra:

• Medicare Part D plans may cover sildenafil. Coverage applies only when it is prescribed for pulmonary arterial hypertension (PAH), not ED.

• Medicare Advantage plans vary by policy. Some plans offer additional benefits beyond Original Medicare, so a plan’s drug formulary and benefits documents are the best place to confirm what is covered.

• If Medicare does not cover Viagra, generic sildenafil may be available at a lower cash price. Generic sildenafil contains the same active ingredient as Viagra and is typically much less expensive, especially with a coupon or a recurring monthly plan on Ro. A healthcare provider can advise whether it is appropriate.

• Medicare does not cover oral medications for ED, but it may cover other treatments. Medicare may cover prescriptions that treat an underlying cause of ED, such as high blood pressure or high cholesterol, and surgical treatment may be covered when it is medically necessary.