HealthRX.com · Printable coverage checklist
Presbyterian Viagra and sildenafil coverage checklist
Use this sheet to check whether Presbyterian Healthcare Services covers Viagra or generic sildenafil. Fill it in before you call member services, ask your prescriber, or visit your pharmacy.
Plan and prescription details
Copy these from your member card and prescription label.
Presbyterian plan nameAs printed on your member card
Member IDFrom your member card
Group numberFrom your member card, if listed
Medicine name as prescribedViagra or generic sildenafil, exactly as written
Strength and form as prescribedCopy from the prescription label
Prescriber nameName on the prescription
Pharmacy name and phonePharmacy you plan to use
Gather before you call or visit
Having these ready can shorten the call.
- Bring your Presbyterian member card
- Find the plan's current drug list online or in your plan documents
- Note whether Viagra and generic sildenafil are each listed on it
- Write down the tier shown for each medicine, if it appears
- Confirm whether the drug list mentions prior authorization for either medicine
- Check the drug list for any quantity limit per fill
- Note the name and phone number for Presbyterian member services
Questions to ask your plan or pharmacist
- Is Viagra covered under my Presbyterian plan?
- Is generic sildenafil covered, and is it listed at a different tier than Viagra?
- Does my plan require prior authorization for either medicine?
- Is there a quantity limit per fill for my plan?
- What is my cost for each medicine at the pharmacy I plan to use?
- What steps does my prescriber need to take if prior authorization is required?
- How do I appeal if my request for coverage is denied?
Coverage call and visit record
Record each contact so you can refer back to it later.
| Date | Who you spoke to | Reference number | Answer given |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.