Does Medicare Cover Viagra? 

Erectile dysfunction is a condition that affects men of all ages, and it can have a variety of causes. As men age, however, the odds of suffering from some form of erectile dysfunction go up, and until relatively recently, there weren’t many options for treating this condition.

This all changed in 1996 when pharmaceutical company Pfizer created Viagra (sildenafil citrate). The drug was cleared by the Food and Drug Administration in 1998, and since then, it has been widely prescribed to assist men who experience erectile dysfunction as the result of poor blood circulation.

What is Viagra?

Viagra was originally created in an attempt to resolve cardiovascular conditions. It works by dilating blood vessels to improve blood flow. As a side effect of this vasodilation mechanism, researchers noticed that men who had previously been unable to achieve an erection were able to do so when using Viagra.

Although the drug is still sometimes prescribed for cardiovascular health reasons, it is by and large considered a drug specifically for erectile dysfunction. While it is not the only prescription drug on the market to treat the effects of erectile dysfunction, it is one of the most commonly prescribed. In many cases, it is a first-line treatment before additional treatment options are considered.

It should be noted that Viagra is not used to treat erectile dysfunction caused by psychological concerns. While Viagra may assist men in achieving an erection in cases where the cause of erectile dysfunction is purely psychological, Viagra does not have any psychoactive effects. Additionally, Viagra does not cure erectile dysfunction, but rather, it is taken approximately one hour prior to sexual intercourse in order to achieve an erection. After the effects have worn off, men who suffer from erectile dysfunction may notice a recurrence of symptoms.

Will Medicare cover Viagra?

Because Viagra is a prescription medication, it can only be obtained by visiting your primary care physician or related medical specialist. As erectile dysfunction disproportionately affects older men, it’s common among male seniors to wonder if Medicare benefits cover Viagra.

Before discussing coverage, it’s first important to understand how Medicare provides coverage for prescription drugs. In cases where a prescription medication can be purchased from a retail pharmacy for use by Medicare recipients at home, coverage is supplied by Medicare Part D. This is the prescription drug benefit of Medicare, and it is optional coverage that requires a separate monthly premium and deductible. Copays may also be required for some Medicare Part D items. Part D coverage is available through a stand-alone Prescription Drug Plan if you have Original Medicare, or, as an alternative, you can enroll in a Medicare Advantage plan that includes your Part D coverage.

Although Medicare Part D covers a wide variety of prescription drugs, these plans typically do not cover Viagra. This is because Viagra and the associated erectile dysfunction it treats are considered lifestyle issues and not medical necessities. As with all things related to Medicare coverage, benefits are only supplied for medical items and services that are deemed necessary to preserve life and treat medical conditions that threaten health.

Viagra coverage for off-label use

Medicare may cover Viagra if it is prescribed to treat a cardiovascular condition. Because this would be considered an off-label use in some cases, you may need to get your physician involved to assist you in filing for an exception waiver. This waiver would be obtained in cases where a drug is not covered by Medicare benefits under Part D, but your doctor believes that the prescribed treatment is the most suitable for your situation to preserve health.

To learn whether Viagra or any other specific medication is covered by your Part D benefits, you will find your coverage details in your plan’s formulary. This is a list of all covered medications in your Medicare Part D plan, and this list may also provide additional information about each covered medication, including information about restrictions, quantity limitations and other stipulations pertaining to specific drugs and your coverage.