ED Medicine and Insurance

By PetiePal Latest Reply 2011-05-25 16:28:07 -0500
Started 2011-05-25 08:32:45 -0500

So I recently was prescribed a sample of Cialis. The 3-4 pill bottle cost me $75! Apparently Cialis or Viagra are not covered by Aetna health insurance. I had our company's HR rep look into it as my issues are likely Diabetes-related, and still no it's not covered.

I'm going to the gym and trying to lose more weight (273.3 lbs right now) but I may need things like this in the meantime. Do I have any other options that might be more cost-affordable in the interim?

12 replies

cheetah1976 2011-05-25 16:28:07 -0500 Report

I would ask you insurance if they cover if due to diabeties. My ex-husband was able to get approval for it with Atena a few yours back.

Duel 2011-05-25 15:25:08 -0500 Report

I've seen a Herbal Viagra called "Formula to boost libido". It says in the bottle something like Herbal Viagra alternative if I remember correctly and it's sold in pharmacies like Rite Aid, CVS. It costs $15.

PetiePal 2011-05-25 15:26:19 -0500 Report

Yeah I've seen a bunch of those, but I have to be careful what I take. Supplements and all that can act screwy with other meds and they don't recommend you take it.

kdroberts 2011-05-25 13:18:22 -0500 Report

Call up your insurance provider and ask if the denial is an Aetna denial or a policy denial.

It's common for insurance companies themselves to blanket not cover things, in this case it's fairly straightforward (although not always easy, quick or without frustration) to get them to override the denial and cover it. Some drugs have age restricted coverage, ADHD drugs are often cut off at 18 or so, ED drugs not covered until 60 or so, things like that. In your case, complications due to diabetes would be a very strong case to get it overridden and covered. Your doctor needs to file an appeal with the reasons why it should be covered.

When your employer is shopping for policies they are usually given a selection that fit within a certain budget. These almost always have things that are not covered in any circumstance in order to keep the casts down. If it's a policy denial like this, there is nothing you can do.

The only other bit of hope if you really do need these drugs is that Viagra comes off patent in late March next year and you can be sure that there will be a generic alternative available very, very soon after that.

PetiePal 2011-05-25 13:24:21 -0500 Report

Excellent piece of advice. The HR rep had just said our plan does not cover these drugs and does not look to in the near future. I may contact Aetna directly and see what I can do.

kdroberts 2011-05-25 13:27:34 -0500 Report

Make sure with Aetna, the HR rep may just say the plan doesn't cover it because Aetna generally doesn't cover it. It does sound like you may be out of luck though. Talk to your doc about samples as well, the reps for those drugs love to give out samples of them!

PetiePal 2011-05-25 13:38:22 -0500 Report

Yeah I'm going to hit up my general practice doctor for that and I'm seeing a urologist soon enough.

realsis77 2011-05-25 13:02:55 -0500 Report

Hi. These perscription company's should be ashamed! The costs of medicine is so sky high! And they pick and choose what they cover! Id look into a pharmacy like wallmart and sometimes they have extra plans or incentives that can give you a discount. Or you can call the company and ask for a coupon or reduction card and they usually hand those out! That's probably your best bet! That way you can get a discount on what your pescribed. I don't believe they make generics yet for male enhancement because the drugs are newer and I believe they have to be out a number of years before they can get generics. But id definately call the company! They advertise savings for those drugs all the time! I wish you the very best and hopefully the company's will offer some savings to you!

PetiePal 2011-05-25 13:08:55 -0500 Report

There are no generics for either…this is one of those quality of life drugs, where even though my sugars are under control I'm fairly healthy and I'm taking care of my blood pressure I may have issues still due to diabetes. Kinda a low blow they don't cover ANY of it.

realsis77 2011-05-25 14:50:26 -0500 Report

Well I hope you can get a savings card from the company! It does blow that insurance company's can tell us what we can and can't have!

LabRat90 2011-05-25 08:43:45 -0500 Report

I don't know if it's my place to say, since it was an accident I found out. Back when there were no meds for this issue, my dad used to use rubber bands. Please don't make me explain.

PetiePal 2011-05-25 08:49:48 -0500 Report

LOL. That's a new one. I was talking more towards how to get these prescriptions at a much cheaper cost. I should look into perhaps Wal-Mart pharmacy or something

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