Cialis and insurance?

Yes it's common... and there's not much to fight since having sex is consider a recreation and not a medical necessity.

You should enable your email address here and maybe someone can recommend another source of the meds from outside the US... We can't discuss it here since it's against the law.

Hi Chattybill

In the UK, health insurance does not pay for any outpatient drugs. We have a national national health service, which is administered via local areas who are meant to pay for outpatient drugs, but they are varied. My surgeon prescribed Cialis, but my local NHS refused to pay, although others will. I have found an online UK supplier who does not charge too exorbitantly (circa 55GBP per 28). I have found that a daily Cialis is more convenient that on demand Viagra, allows more spontaneity. ED is an issue, but also affecting this is stress, and I went into this with some issues also.

Chattybill

My insurance company called my URO and he told them it was a medical necessity and they approved Cialis daily 5mg for a year. All I pay is my copay.

Rick 

I'll add that you are entering a special corner of hell in the insurance world. For everything you do, you'll need to be sure you are in-network, pre-authorized, and that meds are on the right part of the formulary.

I was just notified that the pre-authorization responsibility has been moved from my doctor to me as of 2014.

While you are doing battle with your insurance company don't forget to check out what sort of arrangements you can make without them. The drug sildenafil has recently gone generic in the US. I cannot legally be called "generic Viagra" because the generic version is labeled to treat pulmonary arterial hypertension whereas Viagra is for ED. But it is exactly the same chemical compound only in a different dose. It takes five of the generic sildenafil pills to get as much as in one 100mg Viagra but since the generics can be had for a buck each that works out to a five dollar Viagra-equivalent which is rather more affordable even if insurance won't help. You might talk to your doctor about sildenafil and whether it might help you.

You may have to shop around to find a US price at the rate I mentioned. It's a reasonably new generic and I suspect that pharmacies are holding the price high to protect their higher profit margins on the formulary drugs as long as they can. I get mine from a grocery store pharmacy that has the generics for a buck a pill cash. I also priced them at Walmart, thinking I might save some additional money but, oddly, Walmart's price was three times what I am paying. I could also get them direct from my urologist, also a a buck a pill.

Don't let me stop you from bumping heads with your insurance company. But, in the meanwhile, you might look into your cash options so that nothing shrivels up and falls off while you are doing battle with the insurance.

Thanks guys. Very helpful info. I will talk to the doc about the generic sildenafil and see if can make headway that direction. Pardon the pun.

I'm on Medicare and they will not pay for regular supplies of Cialis. Probably the same for Viagra.

I think they did cover the first 30 days for me, but did not do anything further.

One thing I would suggest is that you check the Cialis website. They have (or did when I needed it) a program where they will give a guy a FREE 30-day supply to give it a try. There was no obligation or anything like that.

I don't know if they still have this program, or if anyone else has mentioned this to you -- because I was too lazy to read through all the replies. LOL

In any case, good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Firm erections now briefly happening in early mornings, 2 years post-op.

The "free" month of Cialis is still there as of last week's paper.

Deal is that you either get 30x5mg or 3x20mg based on the Rx you get from the doc.

I've gone through this many times - if you have a "limited pills per month" scheme like me, get TWO prescriptions from your doc.
1 - 30x5mg per month.
2 - 8 (or whatever the max number for insurance is) x20mg

Go to your friendliest pharmacist, as this will be a bit complicated for him.
Take the #1 Rx with the Cialis coupon. Ask the pharmacist to fill the free one, and hold the #1 Rx till next month. But you won't ever fill that one.
Next month, take the #2 Rx, and use that one to get your next 11 months.
Following year, repeat. Remember that Cialis checks the dates on the free ones very precisely, so your next free one will be at 366 days.

Last, ask every medical professional you see for samples, every time you see them. Just a "Hey, Doc? Any "vitamin C" samples these days?" and be happy regardless of the answer. If he is in a good mood and you were polite, maybe ...
One of my docs always grumbles but gives me 1 pack of 3 if he has them, another doesn't like passing them out, so he gives me whatever he has just to be able to tell the next guy there aren't any.

An appeal is almost a given for any ED med. I've done several in the PCa limbo.

I have BC and my Uro wrote a letter telling them it was medically necessary before they would pay for my 5 mg Cialis for one year. All I have to pay is the copay but the copay is higher than my other prescriptions. I have been on them nearly a year with little to show. The anniversary date of my surgery is next week...as is that dreaded PSA test so I guess we will assess then on what course of action to take next.