{"id":19776,"date":"2018-06-17T08:00:47","date_gmt":"2018-06-17T15:00:47","guid":{"rendered":"https:\/\/www.accessrx.com\/blog\/?p=19776"},"modified":"2018-06-17T08:00:47","modified_gmt":"2018-06-17T15:00:47","slug":"does-my-insurance-cover-viagra","status":"publish","type":"post","link":"https:\/\/www.edrugstore.com\/blog\/erectile-dysfunction\/viagra\/does-my-insurance-cover-viagra\/","title":{"rendered":"Does My Insurance Cover Viagra?"},"content":{"rendered":"<ul style=\"list-style-type:none;width:50%;\">\n<li style=\"list-style-type:none;border-bottom-style:solid;border-bottom-width:4px;border-bottom-color:#333;color:black;\">TABLE OF CONTENTS<\/li>\n<li style=\"list-style-type:none;\"><strong><a href=\"#one\">Introduction<\/strong><\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#two\">Why the Bias Against ED Drugs?<\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#three\">What\u2019s a Formulary?<\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#four\">Significance of Tiers<\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#five\">Not All Health Plans Are Equal<\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#six\">Generic Viagra<\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#seven\">Other Generics on the Way<\/a><\/p>\n<li style=\"list-style-type:none;\"><a href=\"#eight\">Ordering Viagra Online<\/a><\/p>\n<\/ul>\n<figure style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"fr-fil fr-dib\" style=\"width: 600px;\" src=\"https:\/\/mediashower.com\/img\/55B1647E-4CF8-11E8-8D48-F0F1584906C1\/bigstock--D-Render-Of-Health-Insurance--193444087_600x.jpg\" alt=\"Health insurance card and a blue stethoscope. \" width=\"600\" height=\"450\" \/><figcaption class=\"wp-caption-text\">Health insurance plans may include drug coverage, but you\u2019ll need to check carefully to see if the medications you use are among those covered.<\/figcaption><\/figure>\n<p id=\"one\"><strong>Introduction\u00a0<\/strong><\/p>\n<p dir=\"ltr\">Health care insurance comes in many forms. For some, the provision of health insurance is the single biggest employee benefit of their job. Employer-provided health insurance plans often allow the insureds to cover members of their family for additional premiums deducted from their paychecks.<\/p>\n<p dir=\"ltr\">Others who work for companies that either are too small to offer health coverage at all or have plans with too many restrictions and high deductibles sometimes opt for individual or family coverage. The price tag for this kind of coverage can be very hefty indeed, but without coverage a single catastrophic health episode can very quickly wipe out a family\u2019s savings and leave it deeply in debt.<\/p>\n<p dir=\"ltr\">Just as the health plans &#8212; employer-provided, individual, or family &#8212; vary, so too does the prescription drug coverage, if any, included in the plans. Gold-star plans with high monthly premiums almost always cover some prescription drugs, but those covered might not be the ones you need to take.<\/p>\n<p dir=\"ltr\">When it comes to Viagra and other so-called PDE5 inhibitors, health insurers have been reluctant to cover these drugs, primarily because of their relatively high prices. Some high-end health plans do cover one or more of these ED drugs but may require high copays.<\/p>\n<p dir=\"ltr\">Hints of change are beginning to appear on the horizon, as generic alternatives to Viagra and other ED drugs come on the market. Two lower-cost generic alternatives to Viagra came to market in December 2017, and more are likely to be introduced in June 2018. As more generics hit the market, competition will almost certainly drive down prices, making it even more likely that insurers will decide to cover them.<\/p>\n<p id=\"two\"><strong>Why the Bias Against ED Drugs?<\/strong><\/p>\n<p dir=\"ltr\">In the views of many health insurers, Viagra and\/or other oral ED drugs are generally lumped together with other so-called lifestyle medications. These include weight-loss drugs, smoking cessation products, and medications, such as Botox and Restylane, that are used for cosmetic purposes. In other words, insurers don\u2019t generally see them as essential and may believe that such drugs are being used to correct problems that patients brought on themselves. When one thinks about it, however, cardiac medications and other such covered drugs are very often needed by men and women whose unhealthy behaviors hastened the onset of those illnesses.<\/p>\n<p>&nbsp;<\/p>\n<figure style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"fr-fil fr-dib\" style=\"width: 600px;\" src=\"https:\/\/mediashower.com\/img\/55B1647E-4CF8-11E8-8D48-F0F1584906C1\/bigstock-Question-Are-You-Covered-Text--214412872_600x.jpg\" alt=\"Man holding a small blackboard with the words Are You Covered in red and white.\" width=\"600\" height=\"400\" \/><figcaption class=\"wp-caption-text\">To find out which drugs are covered by your health plan, check the plan\u2019s prescription drug formulary.<\/figcaption><\/figure>\n<p id=\"three\"><strong>What\u2019s a Formulary?<\/strong><\/p>\n<p dir=\"ltr\">Health plans that include prescription drug coverage almost invariably have a formulary, which is simply a list of all the drugs covered by the insurer, although at various levels of reimbursement. The medications listed in a specific insurer\u2019s formulary are generally broken into multiple categories, also known as tiers. To locate an insurer\u2019s formulary, visit its website or call customer service.<\/p>\n<p dir=\"ltr\">It\u2019s usually not the health insurer itself that decides which medications are covered and which are not in the formulary. That responsibility is generally farmed out to a pharmacy benefit manager, or PBM. The United States has fewer than 30 PBMs, and much of the work in putting together health insurers\u2019 drug formularies is assigned to one of the big three &#8212; CVS Caremark, Express Scripts, and OptumRx (part of UnitedHealth Group). Together these three lay claim to 78 percent of the market and cover roughly 180 million health plan enrollees.<\/p>\n<p dir=\"ltr\">Each of the PBMs has a panel of experts, including physicians, nurses, pharmacists, and other clinical specialists. In addition to putting together drug formularies for health insurers, these panels convene on a regular basis to review new medications, drug safety questions, and other developments that might require formulary changes.<\/p>\n<p id=\"four\"><strong>Significance of Tiers<\/strong><\/p>\n<p dir=\"ltr\">Virtually every health plan\u2019s drug formulary is broken down into tiers, which determine the degree of coverage for each drug included within the formulary. The number of tiers generally range from a low of two to a high of six.<\/p>\n<p dir=\"ltr\">Most common are four-tier formularies. In such formularies, Tier 1 usually includes only preferred generic medications, for which the insured is charged the lowest copay, if any. Tier 2 most often covers nonpreferred generic drugs, and the copay for those is a bit higher. Tier 3 covers preferred brand-name medications, while Tier 4 includes nonpreferred brand-name drugs. Some health plans have higher tiers that cover specialty drugs that demand very high copays.<\/p>\n<p dir=\"ltr\">Navigating the formulary is fairly easy once you\u2019ve grasped the meaning of the various tiers in your insurers\u2019 drug formulary. If a drug appears nowhere in the formulary, it means that medication isn\u2019t covered at all. If you want to buy it, you\u2019ll have to pay the full cash price posted at the pharmacy (minus any discounts, coupons, or rebates).<\/p>\n<p id=\"five\"><strong>Not All Health Plans Are Equal<\/strong><\/p>\n<p dir=\"ltr\">And by health plans, we don\u2019t mean just those offered by <em>different<\/em> insurers. Most major health insurers themselves offer a wide array of health plans, some that are very barebones in their coverage and designed primarily to protect against catastrophic illness or accident. That same insurer may have a number of other health plans, each with increasing coverage and the higher premiums that go with the broader benefits. Generally the more you pay for your health plan, the more comprehensive its coverage and the lower its copays for doctor visits, laboratory testing, hospital stays, and prescription drugs.<\/p>\n<p>&nbsp;<\/p>\n<figure style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"fr-fil fr-dib\" style=\"width: 600px;\" src=\"https:\/\/mediashower.com\/img\/55B1647E-4CF8-11E8-8D48-F0F1584906C1\/bigstock--183460972_600x.jpg\" alt=\"White pill bottle on its side with pills spilling out in a dollar sign form.\" width=\"600\" height=\"333\" \/><figcaption class=\"wp-caption-text\">Prescription drugs can get expensive, and not all health plans may cover the medications you use.<\/figcaption><\/figure>\n<p id=\"six\"><strong>Generic Viagra<\/strong><\/p>\n<p dir=\"ltr\">Generic equivalents to Viagra went on sale in the United States in December 2017, becoming the first generic versions of any ED drug to come to market in this country. Additional generic formulations of Viagra are likely to debut in June 2018, and the added competition between the various generic versions is likely to push prices even lower than they are now. As it stands, generic Viagra, marketed as sildenafil citrate, costs considerably less than the brand-name drug.<\/p>\n<p dir=\"ltr\">A handful of drug formularies for 2018 seem to have taken notice of sildenafil\u2019s arrival and have added the drug, either at Tier 1 or 2. More are likely to follow. \u00a0By this we mean, the formularies now cover sildenafil as a drug for the treatment of ED. \u00a0In lower doses, \u00a0the drug had already been available as a generic alternative to Revatio, a brand-name medication that treats pulmonary arterial hypertension, a form of blood pressure that targets the lungs.<\/p>\n<p id=\"seven\"><strong>Other ED Generics on the Way<\/strong><\/p>\n<p dir=\"ltr\">Autumn 2018 is likely to see the introduction of generic alternatives to two more brand-name ED medications. A generic formulation of Cialis (tadalafil) could hit drugstore shelves by the end of September 2018, and a generic version of Levitra (vardenafil hydrochloride) should follow soon thereafter.<\/p>\n<p dir=\"ltr\">These new generic versions of brand-name ED drugs are sure to intensify competition. And the beneficiaries of all this downward price pressure will be consumers who can look forward to much more affordable prices for this class of medications. And with these lower prices, it is likely that more health insurers will add one or more generic ED medications to their prescription drug formularies.<\/p>\n<p id=\"eight\"><strong>Ordering Viagra Online\u00a0<\/strong><\/p>\n<p dir=\"ltr\">If you already use Viagra &#8212; either the brand-name drug or its generic equivalent &#8212; you might want to consider the many benefits of ordering your medications from a reliable online facilitator such as eDrugstore.com. In business since the late 1990s, the website offers not only brand-name and generic Viagra but other ED drugs as well. Also available through eDrugstore is a limited selection of other lifestyle medications. If you have a doctor\u2019s prescription, you can fax it or scan and email it along with your order. Alternatively, eDrugstore can set up a complimentary online consultation with a member of its team of licensed U.S. physicians, who can authorize a prescription if appropriate. To learn more, click here to visit eDrugstore\u2019s <a href=\"https:\/\/mediashower.com\/ce2\/69397\/280\/103\">Erectile Dysfunction page<\/a>.<\/p>\n<p><!-- Media Shower Impressions --><\/p>\n<div class=\"ms_article_id\" style=\"display: none;\" data-ms-article-id=\"69397\"><\/div>\n<p><!-- \/Media Shower Impressions --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>TABLE OF CONTENTS Introduction Why the Bias Against ED Drugs? What\u2019s a Formulary? Significance of Tiers Not All Health Plans Are Equal Generic Viagra Other Generics on the Way Ordering Viagra Online Introduction\u00a0 Health care insurance comes in many forms. For some, the provision of health insurance is the single biggest employee benefit of their [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":19777,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_autoblog_aioseo_focus_keyphrase":"","_autoblog_aioseo_title":"","_autoblog_aioseo_description":"","footnotes":""},"categories":[20,17],"tags":[820,184],"class_list":["post-19776","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-erectile-dysfunction","category-viagra","tag-health-insurance","tag-viagra"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO Pro 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"TABLE OF CONTENTS Introduction Why the Bias Against ED Drugs? What\u2019s a Formulary? 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