Many men in the US assume insurance is always the cheaper way to fill a prescription. With tadalafil, that is not always true. Plenty of health plans limit or exclude erectile dysfunction treatment, and even when they cover it, the copay, deductible and quantity caps can make the "covered" price higher than a straight cash price. Before your next refill, compare the two side by side. Our main guide to generic Cialis explains the medicine itself; this article focuses on the money.
Why insurance coverage for tadalafil varies so much
Tadalafil is prescribed for two different reasons: erectile dysfunction (ED) and the urinary symptoms of an enlarged prostate (BPH). Many plans treat these differently. A plan might exclude ED medicines entirely, yet cover daily tadalafil 5 mg when it is prescribed for BPH. Others cover ED treatment but cap the number of tablets per month, often four to eight.
Coverage can also come with conditions:
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Prior authorization, where your doctor has to submit paperwork before the plan pays.
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Step therapy, where you must try another medicine first.
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Formulary tiers, which set how much you pay at the drugstore counter.
Five numbers to compare
To make a fair comparison, write down these figures for a typical month:
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Your copay or coinsurance for the quantity your plan allows.
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Where you are with your deductible. Early in the year, you may be paying the full negotiated price until the deductible is met.
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The quantity limit. If your doctor prescribes more tablets than the plan covers, you will pay cash for the rest anyway.
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The cash price per tablet for the same strength from a cash-pay source.
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Your time cost, such as prior authorization delays or monthly trips to the pharmacy.
Once you divide everything by the number of tablets, the cheaper route usually becomes clear.
When paying cash often makes sense
Paying cash tends to work out well when your plan excludes ED treatment, when you have a high deductible you are unlikely to meet, or when the quantity cap is lower than what your doctor prescribed. Because generic tadalafil is now made by many manufacturers, cash prices have fallen a long way below the branded price. For some men, the cash price per tablet is lower than their copay.
Keep in mind that cash purchases usually do not count toward your deductible or out-of-pocket maximum. If you expect to hit your deductible anyway because of other medical costs, insurance may still be the better deal.
When insurance may be the better choice
If you take tadalafil 5 mg daily for BPH and your plan covers it at a low tier, insurance can be hard to beat. The same is true if you have already met your deductible for the year. It is also worth asking whether your plan offers a lower price for a 90-day mail-order supply.
HSA and FSA accounts
Prescription medicines are often eligible expenses for a health savings account (HSA) or flexible spending account (FSA), whether or not insurance pays. Check with your plan administrator, and keep your receipts and a copy of your prescription.
Ordering with a prescription
Whichever route you choose, a valid prescription is required for every order of a prescription medicine. If you decide to buy generic tadalafil online, check that the strength matches your prescription exactly. Licensed doses are 2.5 mg, 5 mg, 10 mg and 20 mg. Higher strengths such as 40 mg or 80 mg are not licensed doses and should only be used if a prescriber has specifically set them.
When you buy medicine online and pay cash, compare the full cost including delivery, and order early enough that you do not run out. You can see the available strengths in our men's health range.
A quick safety reminder
Price should never be the only factor. Tadalafil must not be taken with nitrate medicines, and it can interact with some blood pressure and prostate medicines. Tell your doctor about everything you take, including supplements.
Want to go further? You can see Tadacip 20 (tadalafil 20 mg), or browse everything on the RxPillTab home page.
This is general information, not medical advice. Speak to your doctor or pharmacist before starting any medicine.