Check your insurance plan’s formulary. This list specifies which medications your plan covers. Viagra, or its generic equivalent sildenafil, may be listed under “Erectile Dysfunction Medications” or a similar category.
Prior Authorization
Many plans require prior authorization before covering Viagra. This means your doctor needs to submit paperwork justifying the prescription’s medical necessity. Expect a delay in receiving your medication if prior authorization is needed. Contact your insurance provider directly to confirm whether prior authorization is required for your specific plan and to understand the required process.
Generic Options
Consider sildenafil, the generic version of Viagra. It’s typically significantly cheaper and often covered by insurance when brand-name Viagra isn’t. Ask your doctor if switching to a generic is suitable for you.
Cost-Sharing
Even with coverage, you’ll likely have cost-sharing. This could involve a copay, coinsurance, or deductible. Your out-of-pocket expense depends on your specific plan’s details. Review your Explanation of Benefits (EOB) statements carefully to understand what you’re responsible for.
Alternative Medications
If Viagra isn’t covered or is too expensive, discuss alternative erectile dysfunction medications with your doctor. Insurance coverage varies by drug, so another option might prove more affordable.
Negotiating with Your Provider
If cost remains a concern, consider contacting your insurance company’s customer service. They might be able to offer assistance with navigating plan benefits or suggest programs that lower medication costs.
Helpful Resources
- Your insurance company’s website Your insurance company’s member services phone number Your doctor’s office for assistance with prior authorizations
Tips for Lowering Costs
Explore manufacturer coupons or patient assistance programs. Compare prices at different pharmacies. Consider a 90-day supply to reduce the frequency of refills.
