Erectile Dysfunction (ED) Treatment
Covered by Aetna in California

Sildenafil 50mg orally 30–60 minutes before sexual activity (as-needed dosing); titrate to 100mg if inadequate response or reduce to 25mg for side effects. Half-life 3–5 hours. OR tadalafil 10mg orally 30 minutes before sexual activity (as-needed); titrate to 20mg if inadequate response. Tadalafil 5mg orally once daily (daily-dose regimen) for men who prefer spontaneity or have concurrent BPH symptoms.

Vardenafil 10mg orally 60 minutes before sexual activity — 4–6 hour duration, slightly more selective for PDE5 vs. PDE6 (reduced visual side effects vs. sildenafil). Avanafil (Stendra) 100–200mg 15–30 minutes before activity — fastest onset, fewest food interactions, but non-formulary on Aetna CA standard plan. Vacuum erection device for patients with contraindications to PDE5 inhibitors. Intracavernosal alprostadil (Caverject Impulse, Edex) covered as Tier 3 NPB on Aetna CA, QL 6 kits per 25 days, SPC; appropriate for PDE5 inhibitor non-responders.

Yes — generic sildenafil 50mg/100mg and generic tadalafil 10mg/20mg are Tier 1 on Aetna CA with SPC (Select Plan Coverage) and QL of 6 tablets per 25 days. Generic tadalafil 5mg daily-dose has QL of 30 tablets per 25 days. Patients should confirm their specific plan includes SPC; if not, ED drugs may require medical necessity documentation or a plan exception. Cost with Tier 1 copay: typically $10–$30 for 6 tablets. GoodRx often reduces generic sildenafil to $10–$15 for a 6-count at major pharmacies independent of insurance.

PDE5 inhibitors are contraindicated with nitrate medications (nitroglycerin, isosorbide mononitrate/dinitrate) — combination causes severe hypotension. Dr. Bhavsar screens for nitrate use before prescribing. Alpha-blockers (tamsulosin, doxazosin) used for BPH require caution with PDE5 inhibitors due to additive hypotension. Cardiovascular exercise tolerance is assessed via history — patients who cannot walk two flights of stairs without symptoms should have cardiac evaluation before PDE5 inhibitor use per American College of Cardiology guidance. Per AUA 2018 (reaffirmed 2023) guidelines, PDE5 inhibitors are first-line pharmacotherapy for ED across all etiologies.

Yes. The Aetna CA formulary imposes a quantity limit of 6 tablets per 25 days for as-needed sildenafil (25/50/100mg), as-needed tadalafil (10/20mg), and vardenafil. For daily-dose tadalafil (2.5mg or 5mg), the limit is 30 tablets per 25 days — effectively one per day. These limits apply to plans with Select Plan Coverage (SPC) for ED drugs. If your specific Aetna CA plan does not list SPC coverage for ED medications, you may need a medical necessity exception supported by Dr. Bhavsar's documentation. Patients who need more than 6 doses per 25 days can use GoodRx for additional supply at low out-of-pocket cost.

Controlled hypertension is not a contraindication to PDE5 inhibitors. The key safety issue is concurrent nitrate use — combining sildenafil or tadalafil with any nitrate medication (nitroglycerin, isosorbide mononitrate, amyl nitrite/poppers) causes unpredictable severe hypotension and is absolutely contraindicated. Most first-line antihypertensives (ACE inhibitors, ARBs, calcium channel blockers, thiazides) are safe to use with PDE5 inhibitors with some attention to additive hypotension at initiation. Alpha-blocker antihypertensives (doxazosin, terazosin) require extra caution. Dr. Bhavsar reviews your full medication list and blood pressure before prescribing.

Yes. Dr. Bhavsar can order a fasting morning total testosterone along with LH, FSH, prolactin, and a basic metabolic panel as part of a comprehensive ED workup — lab orders are sent electronically to Quest or LabCorp locations throughout California. If testosterone is below normal range (typically < 300 ng/dL), evaluation for hypogonadism and discussion of testosterone replacement therapy (TRT) or referral to endocrinology/urology follows. Testosterone deficiency is found in approximately 20–30% of men with ED, and addressing it alongside PDE5 therapy improves response rates.

Aetna CA's standard plan lists brand-name Viagra, Cialis, and Stendra as non-formulary, because generic sildenafil and generic tadalafil are bioequivalent and available at a fraction of the cost. Generic sildenafil 100mg was approved by the FDA in 2017 and has been widely available since 2018. There is no clinical difference between the brand and generic formulations. Dr. Bhavsar prescribes the generic, and at most California pharmacies the Tier 1 generic copay makes the prescription $10–$30 for 6 tablets — often cheaper than branded products were even with prior insurance coverage.

Yes. Aetna commercial plans cover telehealth visits for Erectile Dysfunction (ED) in California. TeleDirectMD (Dr. Parth Bhavsar, MD, NPI: 1104323203) is an in-network telehealth provider with Aetna in California. Your standard Aetna telehealth copay applies — typically $10–$40 for most commercial plans. If clinically appropriate, your prescription is sent to your California pharmacy immediately after your visit.

Most Aetna commercial plans in California have telehealth copays of $10–$40. Often $0–$20 for employer plans. Your exact cost depends on your specific plan and whether your deductible has been met. Log into your Aetna member portal or call the member services number on your card to verify your telehealth copay before your erectile dysfunction treatment visit. Self-pay is always available for a flat $49 if you prefer to skip insurance.

If your specific Aetna plan is not in-network with TeleDirectMD in California, or if your deductible has not yet been met, you can book as a self-pay patient for a flat $49 fee — same physician, same quality of care, no insurance needed. You may also be eligible to submit an out-of-network claim to Aetna for partial reimbursement depending on your plan's out-of-network benefit.

TeleDirectMD typically offers same-day and next-day video visits. Book at teledirectmd.com/book-online and select a time that works for you. Most patients are seen within a few hours of booking during business hours. Your erectile dysfunction treatment symptoms are evaluated by Dr. Bhavsar, MD — not a nurse practitioner or PA — ensuring you receive a board-certified clinical assessment.

Yes. TeleDirectMD is operated by Dr. Parth Bhavsar, MD (NPI: 1104323203), a board-certified Family Medicine physician. TeleDirectMD is LegitScript certified, HIPAA compliant, and is contracted as an in-network telehealth provider with Aetna in California. Claims are billed using standard CPT codes (99213/99214) and submitted electronically to Aetna.

Yes. Telehealth visits with a licensed physician are qualified medical expenses eligible for FSA (Flexible Spending Account) and HSA (Health Savings Account) payment. If your Aetna plan applies your deductible first, your FSA or HSA card can be used to pay your portion. The $49 self-pay option is also FSA/HSA eligible.