Medicaid Viagra Coverage
- Medicaid doesn't typically cover Viagra. Learn more about your options to cover the cost of Viagra and the cost of other related drugs that treat erectile dysfunction (ED).
No, Medicaid does not cover Viagra.
Medicaid doesn't pay for the cost of any medications used to treat sexual or erectile dysfunction (ED), including Viagra, also known by its generic name, sildenafil. To be covered under Medicaid’s formulary list, drugs must be deemed medically necessary for the participant’s health, and Viagra does not meet that definition.
Because Medicaid has some autonomy from state to state in setting its policies, it is important that Medicaid recipients check with their caseworker or pharmacist to determine coverage. It is possible that Medicaid may pay for Viagra if it is prescribed for conditions other than ED or sexual dysfunction, provided the drug has been approved for treating that condition by the Food and Drug Administration.
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Does Medicare Cover Viagra?
In most instances, Medicare does not cover Viagra. Original Medicare (Part A and Part B) doesn't typically cover prescription drugs, and it won't cover Viagra.
In some instances, a private Medicare plan may pay for Viagra. For example, a Medicare Part D plan may pay for Viagra prescriptions for the treatment of pulmonary arterial hypertension, which is a condition that causes high blood pressure to develop in the lungs. Typically, however, Medicare does not pay for any ED drugs or drugs to improve sexual functioning.
In 2019, the U.S. Centers for Medicare & Medicaid Services sent guidance to Medicare Part D plans that allows them to offer coverage for some types of sexual dysfunction drugs for menopausal women experiencing symptoms that may be relieved through covered drugs, if desired. Whether the CMMS will ever get on board with Viagra and other ED medications being approved for coverage remains to be seen.
Health Insurance Coverage and Viagra
Some private health insurance plans may cover the cost of Viagra, at least in its generic form. Whether or not coverage is extended may also be dependent on the reason that the drug is prescribed. Much like Medicare, private insurers are usually hesitant to cover the costs of any type of drug that is used for the treatment of sexual or erectile dysfunction.
