The limited health insurance coverage for some ED treatments started
Regarding the prescription of Viagra and Cialis, health insurance coverage began on April 1, 2022 for the purpose of infertility treatment. However, there are specific conditions, so if you have not received fertility treatment, please continue to receive the prescription at clinics for erectile dysfunction treatment.
－Government’s efforts to treat infertility－
It is said that there are about 1 in 5.5 couples who are not blessed with children even though they want children, and the number of couples receiving fertility treatment is increasing. However, infertility treatment has not been covered by insurance in principle, and the cost of treatment is high, so it was often the case that they had to give up having children. Therefore, governmental efforts have been made to reduce the financial burden on couples receiving this treatment.
Regarding support for fertility treatment The government will consider applying medical insurance to treatments with clear indications and effects in order to reduce the financial burden of fertility treatment in the outline of measures against the declining birthrate, and expand the support. Therefore, the Medical Insurance Subcommittee of the Social Security Council will apply for insurance from April 1, 2022.
At the same time, regarding the handling of infertility treatment due to the revision of medical fees in 2022, as a general rule, when using medicines used in infertility treatment within the range of efficacy / effect, usage / dose of regulatory approval. It will be covered by insurance. As a result, you will be able to receive prescriptions for Viagra and Cialis under the following conditions.
－Notes on partial revision of drug price standards－
Viagra Tablets 25mg / 50mg, Viagra OD Film 25mg / 50mg, and Cialis Tablets 5mg / 10mg / 20mg
Viagra Cialis is covered by insurance only if all of the following requirements 1) to 7) are met for the purpose of treating male infertility due to erectile dysfunction.
1) As a general rule, doctors who administer this drug have at least 5 years of experience in urology.
2) When receiving a referral and administering this drug to a patient who is being treated for infertility at another medical institution, have a system that can share necessary information in cooperation with the referral source facility. ..
3) Patients who have been diagnosed with erectile dysfunction according to the guidelines for erectile dysfunction prepared by related academic societies upon administration of this drug. In addition, state that fact in the medical record.
4) The patient or his partner receive the applicable medical management within 6 months from the date of administration of this product.
5) When administering this drug, the quantity should be based on the timing method per medical treatment.Only for one cycle and 4 tablets or less.
6) When this drug is repeatedly administered, the duration of administration should be 6 months as a guide. If administration is continued for more than 6 months, the necessity of continuation should be reconsidered.
7) When prescribing this drug in insurance medical treatment, the remarks column of the prescription indicates insurance medical treatment.
Regarding the handling of medicines used in fertility treatment for insurance benefits (Ministry of Health, Labor and Welfare, Japanese only) →