Since its introduction 10 years ago, millions of men have flocked to buy Viagra. The erectile dysfunction drug has been a tremendous success, and its proponents are not about to stop selling it now. But what happens when you have a health condition that makes you ineligible for public assistance? Can you still get affordable Viagra?
It’s not always easy being sick. Especially when you’re young and healthy, you put yourself in vulnerable positions. You rely on people to take care of you and your needs. Sometimes it feels like a Herculean task to just get through the day. Your health crisis can feel isolating. You can’t go to the grocery store without feeling anxious about whether or not you’ll be able to pay. Will you even have enough energy to make it through the day? It’s a scary question, especially since you’re not prepared for a situation like this one.
The simple answer is yes, Viagra can be covered by insurance. However, knowing when it is appropriate to use insurance and when to pay out-of-pocket for your prescriptions can be a difficult task. Typically, health insurance covers the costs of routine doctor visits and prescription medicines. However, there are exceptions for medicines that are considered “high-cost” or “high-risk” medications.
In this article, we’ll explore the different situations where you might have to pay out-of-pocket or where your insurance coverage might exclude medication costs.
When Is Viagra Exempt From Insurance Coverage?
The short answer is never. However, there are exceptions. In general, drugs are considered “high-cost” if they are expensive to make or difficult to obtain. Some medications are also considered “high-risk” because they have a high potential for abuse. Examples of high-risk medications include opioid pain relievers, anti-anxiety drugs, and stimulants. In most cases, insurance coverage for these types of medications doesn’t apply. It is imperative to note here that even non-opioid pain relievers are extremely costly to make. So, while insurance might cover your costs for a bottle of Ibuprofen, it won’t cover the costs of an opioid like OxyContin or Vicodin.
Can You Still Get Insurance Coverage?
The simple answer is yes, you can still get insurance coverage for Viagra. However, you have to be aware of a couple of caveats. First, make sure you are actually getting a good deal from your insurance company. The premiums for Medicare Advantage plans usually exclude the costs of prescriptions. So, while it might be “free” for your insurance company to cover the cost of your prescription, they actually make money off your coverage. This is why it’s imperative to shop around for pharmacy and medical coverage before locking yourself into a contract. You don’t want to pay for coverage that you don’t need or use.
The second caveat is that you have to be aware of how your insurance company will treat your condition. Some companies don’t cover conditions that are considered “pre-existing” or “existing” before your plan enrollment date. So, if you are taking Viagra and have a chronic kidney disease or a history of heart disease, you might have to pay out-of-pocket for some of your prescriptions.
In general, if you are facing high costs and don’t qualify for Medicaid or Medicare coverage, it is advisable to explore your options for insurance coverage. The process of searching for the best medical coverage is called “open enrollment” and is usually available for qualified individuals during the open enrollment period. After that, you will have to pay for all your prescriptions out-of-pocket. It would be best to have your prescriptions filled during the open enrollment period. Otherwise, you might have to wait until the next open enrollment period to get coverage again.
Is It Worth It To Search For The Best Insurance Rate?
An even more crucial question is, “is it worth searching for the best insurance rate?” This depends on how long you plan on being on the drug. If you think you’ll be taking it for only a short time, it’s not worth the effort. But if you think it might be helpful in the long term, it’s worth exploring how different insurance companies score on the price vs. quality scale. In general, if you are looking for a low-cost alternative, it’s best to look for a PPO network. These are insurance plans that allow you to go to any physician or specialist you want. Therefore, if you think you’ll get sick of going to the same doctor and want to try something new, a PPO plan might be the right fit for you.
When Is Viagra Worth It To Use As Preventive Treatment?
In some cases, it is imperative to take medications as preventative treatment. Especially if you have a chronic illness or a history of health problems, it’s important to take medications as prescribed by your physician. However, in cases of mild to moderate ED, it might be better to use Viagra as a preventive treatment. In some instances, medications for erectile dysfunction can help prevent heart disease and stroke. If you’re at high risk for these conditions, it might be better to use these medications as preventative treatment.
In cases where insurance coverage for Viagra is questionable, it might be a good idea to search for alternative medications that are covered by insurance. In most cases, if a medication is deemed “high-cost” or “high-risk”, it won’t be covered. However, there are exceptions for certain types of patients. If you have a condition that is usually treated with medication, it might be a smart move to try and get insurance coverage for your prescriptions. This way, you don’t have to worry about whether or not you’ll be able to pay for your medication. It’s a common fear among the financially vulnerable.
Ultimately, if you think you’ll have difficulty paying for your prescriptions, it might be a better idea to wait until you qualify for Medicare or Medicaid. Or, in cases where your insurance doesn’t cover the cost of prescriptions, try and see if there is a prescription assistance program for people with low incomes.
Should You Try To Wean Yourself Off Of Viagra?
If you’re worried about whether or not you’ll be able to afford your prescription medication, it might be a good idea to try and wean yourself off of it. This is especially the case if you are experiencing side effects from the drug. It is possible to become dependent on Viagra, especially if you are using it for more than a year. In most cases, this will result in a withdrawal syndrome that is similar to drug addiction. This is the reason why many doctors will not recommend patients try to wean themselves off of the drug. It can also make it more difficult to obtain a prescription if you continue to rely on it.
Although it is not always easy being sick, there are cases where insurance coverage for medication makes it possible for you to get the treatment you need. Don’t let your anxiety about money get in the way of you getting the best treatment. If you have questions about whether or not insurance will cover your costs for medical treatment, contact your insurance provider. They will be able to assist you in finding the best coverage for you.