Erectile dysfunction is a medical condition where a man is unable to sustain or obtain an erection for a significant period of time. ED can be caused by a number of factors, some of which include:

• Medication interactions
• Chronic illnesses
• Fatigue
• Alcohol consumption
• Poor circulation resulting in reduced blood flow

Occasional ED is normal and is not considered a medical problem. However, the chronic and long-term inability to achieve erection can be treated in a variety of ways. Some doctors advocate lifestyle changes, while others prescribe drugs to counteract the effects of ED.

Viagra and Other ED Drugs

Viagra is the brand name for a compound called sildenafil citrate, that works by inhibiting certain enzymes in the blood. Other ED drugs such as taldalafil, marketed as Cialis, and vardenafil, under the brand name Levitra, also provide relief.

While there have been side effects associated with the use of ED drugs such as blurry vision, headaches and digestive issues, for the most part these drugs are used successfully and safely by millions of men. The patent on Viagra has been extended to 2020, meaning that Pfizer Pharmaceuticals, the drug’s manufacturer, will be able to continue to market brand-name Viagra for several more years. This also means higher prices for those using this version of the drug.

Is Viagra Covered by Health Insurance?

The high cost of Viagra, averaging $22 to $24 per pill, leads many men to seek health insurance coverage for this drug. However, insurance companies have been ambivalent about their coverage for ED drugs, with some insurers picking up the cost and others refusing to cover any portion of the bill.

For example, Medicare Part D does not cover any type of erectile dysfunction drug. This is bad news for the elderly population, the largest group of men who need the help provided by ED medications. On the other hand, many private insurance plans, such as Aetna and United Healthcare, make provisions to cover the cost of Viagra or other ED drugs when deemed “medically necessary” by a doctor and if the patient’s state of residence requires them to do so. HMOs usually cover Viagra with a higher co-pay than for other drugs.

The only way to know if Viagra is covered by your individual health insurance company is to examine your insurer’s formulary. This is a list of drugs that are covered at various rates by the insurer. If you have a prescription drug plan, you will note that the company usually covers drugs in three levels: Tier I, Tier II, and Tier III. Tier I medications are considered essential and usually involve the cheapest co-pays. Tier II medications may be brand-name or more expensive products for which the patient must pay a higher portion of the bill. Tier III drugs are usually considered non-essential and are billed at the highest rate. Most insurers list Viagra and other ED drugs as Tier III.

How Can I Have My Health Insurance Pay for Viagra?

The most important thing to do is examine your company’s formulary and determine if Viagra is covered. If the company pays all or part of the bill, talk to your doctor about your ED condition. A doctor must diagnose you as having ED and must meet the standard of testing for that condition required by the insurance company. You may also want to talk to your insurer directly to determine their requirements for covering ED drugs.

Viagra vs. Birth Control

A debate has been raging for some time over the fact that many insurers make some provision to pay for ED drugs but do not cover birth control pills for women. ABC News reports that several lawsuits have been filed against insurers for failing to cover birth control when they have provisions to cover erectile dysfunction drugs. The question remains unanswered as to what the government will do to force insurers to provide birth control coverage or coverage for ED, but many critics fear that forcing insurance companies to provide coverage for these drugs will raise the cost of both insurance and the drug itself. Others argue that government intervention is the only way to make companies focused on profit provide cost-effective drugs for both sexual dysfunction and birth control.

Viagra can be very helpful in overcoming the embarrassing and psychologically damaging condition of erectile dysfunction. However, unless your particular insurance provider covers the drug, you may find that the cost is prohibitive for regular use.