Does Medicaid Cover Viagra?

Medicare Benefits Solutions
Dec 26, 2020

For treating erectile dysfunction, Viagra is one of the most commonly prescribed medications available. You may hear this drug called Sildenafil or Revatio, as these are the generic versions of Viagra. You can’t get this pill without a prescription, so you have to go through your primary care provider to get it. Erectile dysfunction is very common in a large portion of the male population, especially as they start to age. Viagra remains one of the most common options for treatment. This leads many people to wonder if their Medicaid or Medicare benefits will cover the cost. 

Defining Erectile Dysfunction

Erectile dysfunction is a medical condition where a male has a problem getting an erection. Men over the age of 40 are the biggest class of the population that experiences this problem. Erectile dysfunction is often due to inhibited blood flow to the genital region, which makes it very hard for you to get or keep an erection. 

There are several reasons why you could develop this medical condition, and some of them are due to physiological changes your body undergoes as you age. Depression can cause this condition, and this can lead to anxiety and worry. In turn, these feelings can actually worsen your erectile dysfunction symptoms, and this can push you further into depression or increase your anxious feelings.

Diseases that impact your blood vessels throughout your body can also cause it. Things like heart disease, diabetes, and high cholesterol are common health issues that impact your ability to get or keep an erection. These diseases will cause your blood vessels to sustain damage, or they’ll clog them. Damaged blood vessels will slowly lose their elasticity, and this makes it much more difficult to control the blood flow to various tissues and regulate blood pressure.

If plaque starts to build up on the inside of your blood vessels, this can lead to reduced blood flow. Blood will have difficulty getting to the tissues throughout your body, and this can lead to increased stress on your heart and aggravate any current medical conditions you have. Other causes of erectile dysfunction include prostate cancer, obesity, spinal cord injury, or swelling. 

How Viagra Works

Viagra works to stimulate blood flow and help your blood vessels dilate to counteract any potential problems you may have to get or keep an erection. Viagra can take between 30 and 60 minutes to work from the time you take it, and you should only take it on a strictly as-needed basis. You can take it any time up to four hours before you engage in sexual activity because it’ll only start to work if you get stimulated. 

You can get three main doses of this medication 25 milligrams, 50 milligrams, and 100 milligrams. Your primary care doctor will decide which dosage meets your needs. There are very few side effects associated with taking Viagra. However, if your erection lasts longer than four hours, you should seek medical help. 

Does Medicaid Cover the Cost of Viagra?

Since Medicaid is a government-funded insurance plan, it will typically only cover medical services and prescriptions that it finds medically necessary. Unfortunately, Viagra or other medications to help treat your erectile dysfunction do not fall under this medically necessary category. This means you typically end up paying for it out of your own pocket, and it can cost up to $60 per pill. The only way Medicaid would cover it is if your doctor prescribed it for another medical condition where having this medication would be seen as medically necessary for your treatment. 

However, there is such a thing as dual eligibles with Medicare benefits. All dual-eligibles mean is that you qualify for both Medicaid and Medicare insurance. Under Original Medicare, it can be challenging to find a Part D plan that will cover Viagra as a brand name. However, several Part D plans will cover Viagra as long as it’s under the generic name of Sildenafil. Also, a lot of Medicare Advantage plans will cover the generic version of Viagra.