Is sex medically necessary?

As a physician, I encounter many times when a medical treatment or medication is denied by an insurance company saying that it is not medically necessary. Patients get upset since it is hard to understand what this means. By medically necessary, it means that the patient cannot do without the specific treatment. Since insurance companies are for profit, they will try to save money and search for cheaper alternatives for treatments. This brings me to the topic of sex. Many male patients have ED, i.e. erectile dysfunction. Many of them benefit from Viagra or Ciales, medications that treat ED. Most insurance don’t cover these medicines, however, Medicaid, the governments insurance for the poor, covers one pill a month. Other insurances cover up to six pills a month. Every time I prescribe it, I wonder, how did the government come up with having one erection a month, medically necessary?