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Viagra Erection Pills Covered by Medicare, Medicaid or Obamacare?

The ‘little blue pill’ is the most popular drug for erection issues but it can be costly. Each pill runs about $10 each depending on where it’s purchased, so for many seniors it would nice if the medication was covered by Medicare or Medicaid.  The kicker is the federal government made a rule in 2007 that keeps loss of erections sexual dysfunction drugs from being covered.  While that rule is typically enforced, a new study shows some patients did get the government to chip in for their Viagra.

In a government study more than $3 million dollars went towards the purchases of Viagra. The Centers for Medicare and Medicaid Services (CMS) said the slip ups were not intentional and they will look into recovering their money through insurance companies.

CMS Administrator Donald Berwick, MD, said CMS will determine whether it’s “appropriate and cost effective” to reopen final payment decisions for 2007 and 2008 in order to “recover the costs of claims for drugs used for the treatment of sexual or erection problems paid in those years.”

Medicare and Medicaid will cover drugs like Viagra or Cialis if it is prescribed by a doctor for another reason other than sexual problems. For example, Viagra would be covered if it were prescribed for pulmonary hypertension, a heart condition that can be improved with Viagra. The treatment is only covered if the FDA has approved the erection difficulty drug as a treatment for other problems.

The report suggested a few changes for the Centers for Medicare and Medicaid Services:
*Strengthening internal controls to make sure that only drugs explicitly covered by Medicare Part D are reimbursed
*That CMS work with the FDA to maintain a comprehensive list of drugs that are FDA-approved for ED treatment — and should not be covered for that purpose
*Regularly disseminate that list to insurance companies that administer Medicare Advantage plans