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Posted 7/16/2013 3:07 PM (GMT 0)
Have any of you had any luck getting your health insurance carrier to pay for part of the cost for Viagra, Cialis or Levitra?  The pills are very expensive and I'm wondering what everyone's experience has been with insurance.  Thanks.
Posted 7/16/2013 3:35 PM (GMT 0)
Mine , an insurance specific to Hawaii, HMSA, will get you maybe 5-6 a mos for a cheaper price. Not sure how much, I get mine thru various online pharmacies thru canada, and they work.
Posted 7/16/2013 3:44 PM (GMT 0)
7 pills a month, no more (Aetna). Very frustrating and expensive
Posted 7/16/2013 5:36 PM (GMT 0)
I get 7 pills per month. 3-month supply (21 pills) costs me a $50 copay.
My Uro's office was able to give me some Cialis samples, which helps.

-Gedman
Posted 7/16/2013 6:13 PM (GMT 0)
my insurance allows me 7 or 8 20mg Cialis pills a month (I forget) and my cost is like $12 a pill.  generics just cost me $160 for a 2-year supply (180 pills).  now do you see why I forgot cool ?

ed

 

Posted 7/16/2013 6:26 PM (GMT 0)
NONE here. Blue Cross of Louisiana
Posted 7/16/2013 9:47 PM (GMT 0)
Thanks, everyone. My insurance is CIGNA. Anyone have any experience with them re Viagra or Cialis?
Posted 7/16/2013 10:01 PM (GMT 0)
check with Cigna, a phone call
Posted 7/16/2013 11:46 PM (GMT 0)
30 per month cialis, my cost $47. I thought that was too high. through aetna/caremark, they are 5mg though, more for daily blood flow to aid in healing, as opposed to instigating a "chub"
Posted 7/17/2013 2:19 AM (GMT 0)
Insurance looks at this group of drugs as recreational...Most of us who have felt it was worthwhile to take them have found alternative supply sources which can provide considerable savings...open discussion of these alternative supply sources is frowned upon as some are not exactly legal....
Posted 7/17/2013 2:30 AM (GMT 0)
We had to have our Uro call the insurance company and specifically tell them it was needed due to PCa and prostatectomy, needed for therapy not just sex and they pay for 30 pills per
Month now that it is deemed therapy and me ideally necessary. Don't know if that would make a difference with your insurance or not but certainly can't hurt to have them give a call

Best of luck
Susan
Posted 7/17/2013 5:50 AM (GMT 0)
My Uro had to write a letter saying Cialis was "medically necessary" and BC agreed to pay for one year. However, the copay is higher  $50 compared to $20 paid on most prescriptions.
Posted 7/17/2013 7:54 AM (GMT 0)
I had CIGNA through my employer. They limited my Cialis to 6 pills per month. That was 6 pills regardless of dosage. Thus I could get 6 pills of 20 mg tablets or 6 pills of 5 mg tablets. The co-pay was about $30 for the 6 pills as I recall.  Needless to say I ask the doctor for a Rx for 20 mg Cialis and I would cut them into thirds. I would also get a 90 day Rx from the doctor and use my long term drug plan and then the $30 copay would give me 18 pills.  My employer switched to BC/BS about 3 years ago and same outcome. Thus I also use an online pharmacy and buy the generics. Same effect for me and only about $1 per pill.
Posted 7/17/2013 12:16 PM (GMT 0)
We tend to get a little fixated on our insurance and sometimes forget to check the cash price at discount pharmacies. Walmart used to be a realtively inexpensive place to get Levitra when I couldn't get my insurance to cover PDE5i drugs in useful quantities.
Posted 7/17/2013 3:00 PM (GMT 0)
I have TRICARE so went through Expressscripts.  Initially they only wanted to provide 6 pills per month, but after a couple weeks of paperwork trading between the URO and Expressscripts I now have one 5mg per day, 90 day supply, good for a year's worth.
Posted 7/17/2013 3:22 PM (GMT 0)
My URO wrote me a script for 5m cialis post surgery. First script was free, just got it refilled, $162 for thirty day 5mg. I didn't think that was right so called insurance co., blue cross, they said for that particular drug I needed dr to get pre authorization, for particular conditions and it would only be $45 co-pay.

I thought that sounded a lot better than $162, but since found out the only condition it can be authorized for is BPH. I don't qualify as I no longer am in possession of my prostate..... confused

Thinking I may try an off shore pharmacy??
Posted 7/17/2013 4:25 PM (GMT 0)
Nothing here, even if it is "medically necessary" :(

 

Posted 7/18/2013 12:45 AM (GMT 0)
I have Cigna too with CVS Caremark for RX and they wouldnt cover it. I had made phone calls ,written letters and had the Surgeon try- no luck. However, I worked out something with the Hospital pharmacy for some sildenafil, 20mg. Not working yet. Good luck, I know it's very fustrating.
Posted 7/18/2013 4:45 AM (GMT 0)
I have CIGNA and my copay is $35/month for 12 pills regardless of which ones. Within a brand like Cialis, I cannot quite understand the logic of approving the same number of pills regardless of the dosage size. It's 12 of the daily 5mg or 12 of the 20mg (36-hr).

A lot depends not only on the insurance carrier but the contract that has been worked out with the employer. That is why several of us on here who have CIGNA have totally different copays.

I got my first month of Cialis for free since the doc had me on the 5mg daily tablets to start. The Cialis Web site has the freebie offer and you can enter a few pieces of info and get your coupon to take to the pharmacy. My doc now gives out that info to all his patients after surgery.

..
Posted 7/19/2013 1:50 AM (GMT 0)
I just looked at the drug formulary for my insurance and Viagra is covered but and this is a big but, it is a tier 3 drug and that means top copay also there is a supply limit but don't know what that is.
Posted 7/19/2013 2:52 AM (GMT 0)
Steven D,

I remember looking up Cialis for daily use in my insurance companies formulary once and finding the same thing. Their stated copay was $85 per month for two packs of fifteen pills. I decided I could afford that (barely) and went to my uro and got a scrip and then tried to fill it. Nope. Finally got someone at the insurance company to explain to me that they would only pay for three pills per month. Leaving aside the fact that that dose would be insufficient to treat mild ED in a spider money, there was also the problem that the drug was only available in packs of 15 and you couldn't even buy three pills.

You might inquire about the limit before you get the scrip.
Posted 7/19/2013 3:01 AM (GMT 0)
I don't have a dog in this discussion per say, but now curious, for any of you on Medicare only, does Medicare allow or pay for ED meds?

david
Posted 7/19/2013 3:43 AM (GMT 0)
Purg.
From the Cialis website.
"CIALIS is not covered by Medicare insurance for the treatment of erectile dysfunction."

I would assume it is the same way for other ED medications.
Posted 7/19/2013 3:47 AM (GMT 0)
thanks james, I don't need any of the above, but being on Medicare only, was curious, since they seem to pay for most everything else under the sun.

There really needs to be distinction made with ED drugs, between those of "recreational or casual need" from those men that need it for therapeutic reasons, such as PC guys. It sounds simple enough to me, but guess the insurance firms see if differently.

david
Posted 7/19/2013 4:03 AM (GMT 0)
Yeah I know.

I'm going round and round with my insurance provider, although I may be making some progress.

However, it just feels weird, that when I'm talking to the customer service girls, I have to say I don't need Cialis for recreational use, I need it because my nerves and blood vessels were damaged during a procedure you covered.

There really needs to be a separate diagnosis code and one approved by the insurance institute or the powers that be, so your provider will cover it.

At first my doctor put a ICD-9 diagnosis code: 607.84. It reads, Erectile Dysfunction of organic origin. :-\
I may be organic, but that sure as hell wasn't the reason I have ED, it was a deliberate reason caused by a surgeons knife.
*sigh*
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