Is Cialis Covered By Insurance?

When you need a prescription for a medical condition, but your insurance company leaves you in the cold, it can be infuriating. 

Struggling with erectile dysfunction brings new meaning to frustration. The hope that an ed medication like Cialis® can help can feel like a light in a long, dark tunnel. It sounds dramatic to anyone who hasn’t been there — unable to perform sexually — but for those who know, it’s a very serious matter. 

Prescription drug coverage from your insurance company can make brand name drugs like Cialis affordable, available with just a copay. And because brand name drugs can be very, very costly, insurance coverage can mean the difference between getting the medication or going without. 

TL;DR: Brand name Cialis may or may not be covered by your insurance company, and the best way to find out is to ask. If your insurance refuses to cover this prescription erectile dysfunction treatment, look into the generic version tadalafil or financial assistance for Cialis. 

Background on Cialis (Tadalafil)

Cialis is a brand name drug manufactured by Eli Lilly and Company. It’s used in the treatment of erectile dysfunction, or difficulty getting or maintaining an erection, also known as impotence. It works by allowing blood flow to reach and remain in the penis at the time of arousal. Unlike other PDE5 inhibitors (drugs that work in the same manner), Cialis stays in your system longer, so you can take it as-needed before a sexual encounter, or once-daily, allowing you to be spontaneous.

There is a generic version of Cialis available, called tadalafil. According to standards set by the U.S. Food and Drug Administration, generic drugs like tadalafil must contain the same key ingredients, have the same strength, the same dosage and administration as the brand name version. This means, overall, tadalafil should be as effective as Cialis, at a fraction of the brand name cost.

Do Insurance Companies Cover Cialis? 

When an insurance company covers a drug, it’s listed on what’s known as their formulary. This list of covered drugs varies from insurance company to insurance company, and even from policy to policy. To know for certain whether Cialis is covered by your insurance company, find the formulary on their website or contact them directly. In the meantime, there are indications that brand name Cialis is only covered by insurance companies in very specific situations.

This isn’t likely because the insurance companies are mean or want men to suffer, rather they’ve determined there are alternatives available that may work just as well, for a lower cost. 

Though restrictions vary, these are a couple examples of what insurance companies may require before they’ll agree to cover your Cialis prescription: 

• You’ve tried another PDE5, such as sildenafil, without positive results even after changing the dose 

• You’ve tried multiple other PDE5 drugs or you have a clinical intolerance or justification for not trying those medications

• You’ve tried the generic version without positive results 

The short answer is: Yes, your insurance company might cover Cialis, but you may have to jump through hoops (with the help of your provider’s documentation) in order to get it. 

What Happens When Insurance Won’t Cover Cialis? 

So what if your insurer doesn’t want to cover Cialis or if you’d just rather not deal with the hassle of convincing them you need it? You have a few options: 

Generic tadalafil. The generic version of Cialis is a low-cost option that is both more likely to be covered by insurance, but also more affordable if you have to pay cash. In general, buying tadalafil can save you several hundred dollars when compared with Cialis.

Other PDE5 drugs. Your insurer may be resistant to cover Cialis because they have comparable PDE5 drugs in their formulary. Talk with your doctor about other ED treatment options that might be easier to get covered.

Manufacturer patient assistance. Drug makers often have programs to help patients afford medication when they have financial need. The maker of Cialis has the Lilly Cares program, which may be able to help you get free medication, if you qualify.

The Bottom Line on Cialis and Insurance Coverage 

Call your insurance company to ask if they’ll cover Cialis. If not, you may find they’ll cover the tadalafil prescription, a lower-cost version of the same medication. Barring that, your doctor may be able to provide you with a prescription for an alternate ED medication such as sildenafil.