Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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The lowdown...

  • It depends on your insurance company and insurance plan whether or not they will cover Viagra
  • Many insurance plans do not cover this drug
  • You must look through your insurance plan’s formulary which lists the costs and benefits of your plan to find out if they cover Viagra
  • Currently, neither original Medicare or Medicare Part D cover Viagra

What is Viagra?

Viagra, also known as Sildenafil, is a drug that is prescribed to treat erectile dysfunction. It works by increasing the amount of blood flow to the penis which can cause an erection, in addition to sexual stimulation. It is important to note that Viagra does not protect against any sexually transmitted diseases, including HIV.

Sildenafil goes by other names and is sometimes prescribed in stronger doses to treat other disorders, such as high blood pressure in the lungs.

It is generally recommended that you take it at least thirty minutes, but not more than four hours before engaging in sexual activity. It is not meant to be taken more than once a day and one hour before sexual activity seems to be the most effective.

Enter your zip code into our free search tool and see if any health insurance providers in your state offer prescription drug coveincludingluding Viagara.

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Does health insurance cover Viagra?

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Coverage for Viagra can vary based on your health insurance. It is generally considered a higher cost pill, with an average price of over $20 a pill and many insurance plans only cover this drug partially or not at all.

Some insurers will only provide coverage for Viagra if it is considered medically necessary after an evaluation and diagnosis from a doctor and if your state of residence requires the insurance company to do so.

Other insurance companies will cover it with a much higher copay than for other prescription drugs.

Prescription drug plans usually offer coverage through a ranking system with prescriptions either falling under Tier I, Tier II, or Tier III.

Tier I prescription drugs are considered medically necessary and usually require you to pay the lowest copayment amount.

Tier II medications are either brand name drugs as opposed to the generic version or more expensive in general, in which case the patient will be responsible for paying a larger amount towards the cost of the drug.

Tier III drugs are drugs that are deemed not medically necessary and are therefore the most expensive of the three categories. Most prescription drug plans consider Viagra, as well as other erectile dysfunction medications, to be a Tier III drug.

To find out whether or not your insurance covers Viagra, be sure to check your plan’s formulary. This will list all of the drugs that they cover and will typically tell you what category they fall under if they are using a Tier system and if you must pay a higher copay.

If your insurance does cover it, you will need a specific diagnosis of erectile dysfunction and some insurers may have additional requirements patients must meet before they will help cover the cost of Viagra.

Does Medicare cover Viagra?

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If you have original Medicare, it will not cover Viagra because it does not cover prescription drugs at all. Medicare Part A is hospital insurance, while Medicare Part B covers medical office visits as well as coverage for medical supplies. Medicare Part B does cover pumps for erectile dysfunction.

You would still be responsible for covering the other 20 percent of the cost for this pump, unless you have a Medicare Advantage plan, as well.

Medicare Part D is the prescription drug coverage part of Medicare. However, it does not cover Viagra. Some Medicare Part D plans do cover Cialis, which is an erectile dysfunction drug similar to Viagra.

Medigap also does not cover Viagra, but it can help cover the other 20 percent that you would owe for an erectile dysfunction pump after Medicare Part B contributes the first 80 percent of the cost.

Some Medicare Advantage plans, sometimes referred to as Medicare Part C, will cover Viagra. However, Viagra is still a very expensive drug, so even with these advantage plans, you may still be responsible for covering a pretty high percentage of the cost of this prescription.

Does Aetna cover Viagra?

Some Aetna health insurance plans will cover Viagra or other erectile dysfunction treatment. Many Aetna insurance plans that include pharmacy benefits do not cover drugs for lifestyle enhancement. Therefore, they will only cover Viagra and Cialis when it is required under state laws or if you have purchased an additional rider in conjunction with your pharmacy plan or optional coverage associated with your PPO plan.

If you have been diagnosed with erectile dysfunction by your doctor after a comprehensive history and physical examination, Aetna does consider some erectile dysfunction treatments medically necessary.

Certain medications, such as papaverine or phentolamine, that are injected directly into the corpus cavernosum to cause an erection are covered by Aetna. Additionally, the medicated urethral system for erection, which is a treatment method that requires inserting medication directly to the urethra using a catheter is also considered medically essential and therefore covered by many Aetna insurance plans.

Testosterone replacement therapy and external devices, such as penile vacuum pump, are also considered medically necessary when prescribed by a physician.

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Does Cigna cover Viagra?

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Cigna uses a four-tier system to rank their medications. The first tier consists of generic medications, while the second tier is preferred brand name medications. The third tier is made up brand name medications that are not preferred according to the plan and you will pay more for these and the fourth tier is specialty medications.

Most Cigna health insurance plans do not cover any drugs that are used for sexual dysfunction, including erectile dysfunction, delayed ejaculation, and decreased libido. Some plans might cover medications for sexual dysfunction if it is required by your state law or it is specifically outlined in your plan.

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