Cialis At Va Hospital Pharmacies: What To Know

The Department of Defense Pharmacy & Therapeutics Committee voted to end coverage for brand-name erectile dysfunction drugs, including Cialis, in 2020. This decision was made due to the availability of equally effective generic alternatives. While it is unclear whether this policy change was implemented, it raises questions about the availability of Cialis through VA hospital pharmacies. Veterans can typically obtain medications from VA hospital pharmacies by presenting a prescription from a VA physician. However, the availability of specific medications, like Cialis, may vary and is subject to the VA's formulary list and safety assessments.

Cialis and Viagra are not covered by Tricare

The Department of Defense Pharmacy & Therapeutics Committee voted to end coverage for brand-name erectile dysfunction drugs, including Viagra and Cialis, under Tricare. This decision was based on the determination that generic and brand-name erectile dysfunction drugs have comparable efficacy. If approved, this policy change would mean that drugs like Stendra, Staxyn, Levitra, and their generic versions would also not be covered under Tricare.

The VA has long offered veterans a range of treatments for erectile dysfunction. However, the cost of adding Viagra to the formulary was a significant concern for the VA. According to VA Under Secretary for Health, Dr. Kenneth W. Kizer, the cost of providing Viagra could exceed $280 million annually, which would represent a substantial portion of the VA's pharmaceutical budget. Additionally, a VA pharmacy committee raised safety concerns about the potential interactions of Viagra with other medications commonly used by VA patients.

While the Tricare panel's decision addresses brand-name drugs, it is important to note that generic versions of these drugs may still be available through Tricare. The recommendation to end coverage for brand-name Viagra and Cialis was based on the understanding that generic erectile dysfunction drugs are equally effective. This move towards generic alternatives can help control costs while still providing veterans with the necessary treatments for erectile dysfunction.

It is worth mentioning that the VA's decision-making process considers various factors, including cost implications and safety concerns. The VA's pharmaceutical budget must accommodate a broad range of treatments for veterans' diverse healthcare needs. By assessing the efficacy of generic alternatives and considering the potential financial impact, the VA strives to make informed decisions that balance accessibility and budgetary constraints.

While the VA's focus is on providing comprehensive care for veterans, the high costs and safety considerations associated with brand-name drugs like Viagra and Cialis have led to the recommendation to exclude them from Tricare coverage. This decision underscores the complex nature of healthcare policy, where budgetary constraints and therapeutic efficacy play pivotal roles in determining coverage for specific medications.

Cialis is a long-acting drug

Cialis is a drug used to treat erectile dysfunction. It falls under a class of drugs called PDE5 inhibitors, which work by increasing blood flow to the penis, making it possible to achieve and maintain an erection. What sets Cialis apart from other drugs in its class is its long half-life. The half-life of a drug refers to the time it takes for half of the drug's concentration in the body to be eliminated. Cialis has a much longer half-life compared to similar drugs, which means it stays in the body for a longer period of time, providing a more prolonged therapeutic effect.

The long-acting nature of Cialis offers several advantages. Firstly, it provides a more convenient treatment option for patients with erectile dysfunction. With its long-lasting effects, patients do not need to take the medication as frequently, reducing the burden of having to remember to take a pill before each sexual encounter. This can lead to improved treatment adherence and better overall outcomes. Secondly, the prolonged action of Cialis may result in improved sexual spontaneity. With shorter-acting drugs, the timing of medication intake and sexual activity need to be carefully coordinated, which can take away from the spontaneity of intimate moments. Cialis, with its longer duration of action, offers a more flexible and natural approach to treating erectile dysfunction.

Additionally, the long-acting nature of Cialis has benefits beyond treating erectile dysfunction. As mentioned earlier, Cialis can also be used to treat an enlarged prostate (benign prostatic hyperplasia or BPH). BPH is a common condition in older men, where the prostate gland enlarges and can cause bothersome lower urinary tract symptoms. Cialis works by relaxing the smooth muscles in the prostate and bladder, reducing the obstruction and improving urine flow. The long-acting nature of Cialis makes it a convenient and effective treatment option for men suffering from BPH, as it provides symptom relief over a more extended period.

In conclusion, Cialis is indeed a long-acting drug. Its prolonged duration of action sets it apart from other drugs in its class and offers unique benefits for patients with erectile dysfunction and enlarged prostates. By providing convenience, improved treatment outcomes, and enhanced sexual spontaneity, Cialis has become a valuable option for many individuals seeking effective and long-lasting treatment.

Safety concerns and high costs prevent VA from offering Viagra

The VA has offered veterans a wide range of treatments for erectile dysfunction and will continue to assess new approaches. However, safety concerns and high costs have prevented the VA from offering Viagra specifically.

Firstly, the cost of Viagra would be prohibitive. The VA projected that the cost of providing Viagra could exceed $280 million annually, which would represent more than a fifth of its total pharmaceutical budget. This would have a crippling effect on the VA's ability to provide other necessary medications and treatments.

Secondly, a VA pharmacy committee reviewed safety issues and recommended against adding Viagra to the formulary due to safety concerns. Viagra may interact with other medications taken by VA patients, who often have complex medical problems. The safety of Viagra in this patient population has not been demonstrated, and therefore the potential risks are significant.

In certain cases, VA physicians may decide to provide Viagra "off formulary" if there is an overwhelming therapeutic rationale. However, this is not a common occurrence and is determined by locally established criteria.

The VA has faced criticism for the surge in spending on erectile dysfunction medications, including Viagra and Cialis. Records show that spending on these drugs has increased significantly in recent years, with some recent war veterans receiving erectile dysfunction medication without clear medical diagnoses. However, this may be due to the reluctance of veterans to discuss sexual health issues and the difficulty in obtaining diagnoses for sexual dysfunction, especially for female veterans.

Veterans can appeal medication co-pay discrepancies

The VA offers varying copay rates depending on the veteran's priority group and eligibility criteria. For instance, veterans in priority group 6 with a condition covered by a special authority are exempt from copays, whereas those without this coverage must pay $30 per visit. Additionally, some veterans are exempt from paying copays due to their disability rating, income level, or special eligibility factors.

The VA also provides information on how to pay copay bills and what to do if veterans disagree with the charges or have difficulty making payments. Veterans can review the copay rates for past years, with rates listed from 2020 to 2024.

In terms of reimbursement, the VA outlines that claims must be filed within a certain time limit, typically ranging from 90 days to 2 years, and veterans are encouraged to file within 90 days of the service date. To file a claim, veterans must complete a Veteran Reimbursement Claim Form (VA Form 10-320) and submit it to the regional VA Consolidated Payment Center, along with a valid receipt and supporting documents if necessary.

While the VA does not provide explicit instructions on appealing medication co-pay discrepancies, veterans can utilize the resources mentioned above to understand their copay rates, reimbursement options, and methods for addressing discrepancies or disagreements with charges.

Medication refills are typically not provided at pharmacy windows

While the VA offers veterans a broad range of treatments for various conditions, medication refills are typically not provided at pharmacy windows. Instead, the VA offers several alternative methods for veterans to manage their prescriptions.

One option is to use the refill notice received with the original prescription. Veterans can send this back to the VA pharmacy, which will then process and mail the medications to the patient. It is important to request refills at least 20 days before the current supply runs out to ensure a continuous supply of medication.

Another option is to use the toll-free automated systems offered by many VA pharmacies. These systems provide a convenient way to request prescription refills over the phone.

The fastest and most efficient way to manage refills is through the VA's MyHealtheVet website. This online platform allows veterans to quickly request refills and manage their prescriptions. However, registration is required to access this service.

It is important to note that non-VA prescriptions must be approved by a VA healthcare provider before they can be filled by a VA pharmacy. This is to ensure that the medications are clinically appropriate and align with the VA's formulary, or list of approved medications.

While the VA aims to provide veterans with access to necessary medications, certain drugs may not be covered under VA benefits. For example, a Tricare Panel voted to end coverage of brand-name Viagra and Cialis, moving them to Tier 4 status, which indicates a lack of coverage.

Frequently asked questions