Should Insurance Cover Viagra?

Contrary to popular opinion, Viagra is just as efficient and important as other medications like analgesics, antibiotics, antiretrovirals (ARVs), etc. However, it is still uncertain if this factor serves as a justification for insurance coverage.

Many experts believe that Viagra is more than just a lifestyle drug and as such, should be covered [1]. However, there are experts on the other side who believe that contraceptives should be covered rather than the blue pill.

Is Viagra Covered by Insurance in the USA?

Since Viagra was patented in 1998, the issue of coverage sparked heated debates and controversy. Users in the US often ask: is Viagra covered by insurance?

Well, its coverage in the USA usually depends on one’s health insurance policy. While some plans cover it, others do not [2]. One must also know, that there are two brand-name medications containing sildenafil as an active ingredient – Viagra and Revatio. While some plans that don’t cover sildenafil if prescribed for erectile dysfunction, they might cover it when used to treat pulmonary hypertension.

Which Medicare Coverage Compensates It?

Unfortunately, Viagra – just like some other prescription medications – is not covered under both Part A and Part B Original Medicare [3]. However, one can obtain Medicare prescription drug benefits through a Medicare Advantage Plan or a stand-alone Medicare Part D prescription drug plan. Some of these plans may or may not cover sexual dysfunction medications like Viagra [4].

When one obtains Medicare Part D drug coverage, the plan typically comes with a list of covered medications. If you’re looking to get Viagra coverage, it is advisable to go through the list to ensure that the plan covers this medication.

Viagra may or may not be covered by this plan, however, in the event that it isn’t, one may still be able to save on this med through Pfizer (its manufacturer).

It is worth noting that erectile dysfunction could be caused by a number of factors such as diabetes, prostate problems, and cardiovascular diseases. As such, the treatment of these conditions is typically considered as medically necessary and is covered by Medicare Part A and Part B. Thus, while these plans do not cover medication for ED itself, they may cover tabs to rectify other condition and therefore lead to the improvement of patient’s sexual function.

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Why Is Viagra Covered by Insurance and Birth Control Is Not?

It seems hardly fair that Viagra is covered by some insurance plans while contraceptives are not. As a result, there has been a clamor for a “contraceptive equity” bill to be put in place. Over the years, many women advocates have been pushing for contraceptives coverage with little to no luck. However, the inclusion of the blue pill under many insurance plans has sparked a new line of argument concerning basic fairness.

According to advocates, if insurance can help men improve and enhance their sexual life, it should equally help women to enhance theirs. Fortunately, it appears that this argument and movement could be getting somewhere.

So far, up to 24 states have enacted laws that require health insurance companies to cover prescription contraceptives if they cover other prescription drugs [5]. The law is simple. If the company covers prescription drugs for ED such as Viagra, then it should also cover prescription contraceptives for women.

In the same vein, mandates were sent out in 2009 in two states: Virginia and Texas. This mandate required that employers are given the opportunity to include contraceptives within their health plans.

Thus, although it seems unfair that birth control isn’t covered by insurance unlike Viagra, movements have already been set in place to change things.

In What Other Countries Viagra Is Covered by Insurance?

Apart from the United States, Viagra is also covered in several other countries.

In Canada, prescription drugs are usually covered. It should be noted that there are exceptions to this rule. Prescription drugs that may be classified as lifestyle drugs such as contraceptives are not always covered. However, in the general sense, Viagra is under insurance coverage in Canada [6].

In the United Kingdom, this drug is covered by insurance. However, there are a few rules set in place by the government to regulate this coverage. In July 1999, the availability of sildenafil and other ED treatments on NHS prescriptions via Schedule II was limited to certain regulations [7]. Only two groups of patients can receive treatment for their erectile dysfunction through the NHS. They include:

• men with certain medical conditions like diabetes, Parkinson’s disease and so on;
• men who were receiving treatment for ED as of September 14, 1998.

In the same vein, men who suffer from severe distress caused by erectile dysfunction may also be able to receive NHS treatment in a hospital after proper assessment by a specialist.

Resume

Since the blue pill was introduced and patented, it has been included into several insurance plans. However, some countries are still yet to provide coverage for it as it is classified as a lifestyle drug. Thus, before enrolling in any insurance plan, it is advisable to look through its formulary to ensure that it covers sildenafil for the treatment of ED or any other necessary medications.

References:

1. Should Viagra be Covered by Insurance? By Daniel J. DeNoon. Retrieved: February 18, 2020. Webmd.com.
2. Is Viagra Covered by Health Insurance? By Barbara Marquand. Retrieved: February 18, 2020. Insure.com.
3. Medicare Coverage of Viagra. Retrieved: February 18, 2020. Ehealthinsurance.com.
4. Does Medicare cover Viagra? Medicare Coverage Explained. Reviewed by Hayden Gharibyar, Pharm.D. Retrieved: February 18, 2020. Medicareadvantage.com.
5. Why do Some Insurance Companies Cover Viagra but Mine Does not Cover Prescription Contraceptives? By Ryan Kennelly. Retrieved: February 18, 2020. Help.ihealthagents.com.
6. List of Covered Drugs as of January 1, 2020. Retrieved: February 19, 2020. Canadapost.ca.
7. The Economics of Viagra. By Alison Keith. Retrieved: February 19, 2020. Healthaffairs.org.