Understanding Medicare’s Coverage for Cialis

Medicare is a federal program that provides health insurance to people who are 65 or older or have certain disabilities. One common query among Medicare beneficiaries regards the coverage for Cialis, a drug prescribed to treat erectile dysfunction. The key aspect influencing such coverage involves whether the Medicare plan you have chosen includes prescription drug coverage or not.

Package SizeAverage Price
5 tablets$200
10 tablets$380
30 tablets$1100

Medicare Part D and Medicare Advantage Plans

Medicare Part D, also known as the Medicare prescription drug benefit, includes an optional program to help beneficiaries pay for self-administered prescription drugs. Coverage for Cialis under Part D is not standard, though. Each insurance company and Medicare Advantage plan tends to have its formulary, or list of covered drugs, and these can vary widely.

Does Medicare cover Cialis for BPH?

While erectile dysfunction is the primary approved indication for Cialis, it is also often prescribed for benign prostatic hyperplasia (BPH). Unfortunately, the frequency that Medicare Part D and Medicare Advantage plans cover Cialis for BPH isn’t standardized and, like for ED treatment, is determined on a plan-by-plan basis.

The Role of Tiered Formularies

It is also significant to note the role played by tiered formularies in determining the cost of Cialis under Medicare. In a tiered formulary, different medications have different levels of coverage. Cialis, as a brand-name drug when a generic isn’t available, often falls into a higher tier, which means that patients may have to pay a larger percentage of the drug’s cost.

Exploring Other Options

For Medicare recipients who find that their prescription for Cialis is not covered, or that it falls into a prohibitively expensive tier, there may be other options. Tadalafil, the generic equivalent of Cialis, may be covered under more plans or fall into a lower-cost tier. Medicare recipients can also explore patient assistance programs offered by the manufacturer or non-profit organizations.