Explanation of what TRICARE covers and its beneficiaries

TRICARE is the health care program for uniformed service members, retirees, and their families. It provides coverage for a broad range of medical treatments, however, it is important to note that not all treatments are covered. For example, TRICARE does not cover treatment for sexual dysfunction or inadequacy. These exclusions extend to services and supplies originating from a scientific or medical study, grant or research program, or those provided for free.

Definition and explanation of erectile dysfunction

Erectile dysfunction is a condition where a man is unable to get or maintain an erection firm enough for sexual intercourse. While the ability to get an erection does not define sexual pleasure for the man or their partner, erectile dysfunction can take more than just a physical toll. The emotional impact of the condition can be significant, leading to feelings of anger, frustration, sadness, or lack of confidence. However, there are several treatment options available, including specific medications such as Viagra and Cialis.

TRICARE's stance on covering treatment for erectile dysfunction

TRICARE provides coverage for medically necessary treatment for erectile dysfunction. In particular, male patients 40 years of age or older do not require prior authorization for PDE-5 inhibitors being used for the treatment of erectile dysfunction with Viagra. However, beneficiaries still need to adhere to certain processes when seeking these treatments.

Introduction to Viagra and Cialis as treatments for erectile dysfunction

Viagra and Cialis are among the most popular treatments for erectile dysfunction. They belong to a class of drugs known as PDE-5 inhibitors and work by increasing blood flow to the penis, thereby helping men to achieve and maintain an erection.

Defense Health Agency's 2020 policy on generic Viagra and Cialis

In January 2020, a Defense Health Agency (DHA) panel passed a policy stipulating that TRICARE would only cover the generic versions of Viagra and Cialis. This move aimed to make the treatment of erectile dysfunction more cost-effective while still providing effective medical intervention.

Process for TRICARE beneficiaries to access these treatments

For TRICARE beneficiaries to access these treatments, they must first try a generic version of Viagra before they can switch to a generic form of Cialis to treat erectile dysfunction. This step is essential for ensuring the appropriate use of the two treatments and to prevent the misuse or overuse of one particular drug.

Exceptions and restrictions in TRICARE's coverage of erectile dysfunction treatment

While TRICARE does provide coverage for treatment of erectile dysfunction, there are certain limitations.For example, as of 2021, Medicare prescription drug plans do not cover Viagra, Cialis or other medications used to treat erectile dysfunction.

This policy extends to TRICARE's own restrictions as well.

Beneficiaries can find more specific details about their coverage and potential out-of-pocket expenses using the TRICARE Formulary Search Tool. This tool is designed to help users learn about their prescription, where they can fill it, and how much they may have to pay out of pocket.