How much does Viagra cost? How much is generic Viagra? $1, $3, $40 or $80?

The phone rang and the caller had an important message: People are being asked to pay high prices for the generic drug Viagra, the drug for erectile dysfunction that is no longer protected by patents and is available in generic form.

The differences can be frightening, the caller said: 3 dollars per pill or 40 dollars… (I am not naming the caller, who lives in New Orleans, because he said he did not want to be named, but I will vouch for his authority. He learned about our work through our partnership with WVUE Fox 8 Live and NOLA.com I The Times-Picayune in New Orleans).

Viagra (sildenafil citrate) was approved by the Food and Drug Administration for use in erectile dysfunction in 1998. It is available in 25, 50 and 100 mg; the correct dosage depends on the doctor’s prescription. Viagra can cost $80 per pill.

Gradually people began to notice that the drug Revatio, also sildenafil citrate, which is approved for pulmonary hypertension, has the same effect on erectile dysfunction or impotence. It is sold in the sizes 20, 40, 60, 80 and 100 mg. So if you knew that, then this simple blood pressure medication was your friend, for less than $1 a pill.

Then in December 2017, a generic version of Viagra was approved. Sometimes the approved generic drug is manufactured by the company that makes the brand name. In this case this seems to be the case: Greenstone, a subsidiary of Pfizer, makes one of the generic versions of Viagra; another is made by Teva Pharmaceuticals. The retail price of brand name Viagra can be $60 or even $80 per pill; the generic drug like Tadalafil can cost much less, about $35.

But the price of generic Revatio can be less than $1 per pill. You can search for both on GoodRX, the drug price website. This search shows generic Revatio 20 mg, for $14.81 for 30 pills.

Our informant said he called CVS and Walgreen’s in New Orleans and was quoted as saying that Revatio is about $40 a pill for generic Viagra. But then he spoke to Castellon Pharmacy, an independent discount pharmacy in New Orleans, and received a $3 offer.

There seems to be some deliberate confusion here: Is sildenafil citrate Viagra or is it Revatio? Or does it matter?

It’s obviously both.

“The discovery that sildenafil could cause an erection was an unplanned event. Sildenafil was originally developed by Pfizer for the treatment of high blood pressure (hypertension) and angina pectoris (chest pain due to heart disease). During clinical trials on the heart, researchers discovered that the drug was more effective in causing erections than treating angina pectoris. Pfizer recognized that ED was an unmet medical need and a great opportunity for financial gain,” said L. Anderson describing the drug’s history on the industry site Drugs.com.

“In 1998, the FDA approved Viagra, the first oral treatment for erectile dysfunction, on a priority review”.

Here is a New York Times news article describing the development process of Viagra and several similar articles.

ONLINE STARTUPS THAT SELL VIAGRA

Three online start-ups that deal with men’s health also sell Viagra. The three are a little different, but basically you contact them, get an online consultation and get a prescription for Viagra (or any other erectile dysfunction drug, Cialis or Propecia, the drug for male pattern baldness, or other drugs). The idea behind this is that access to medication can be accelerated by requiring an online consultation rather than a visit to a doctor. While these companies cause a lot of fuss, doctors often suspect that patients could be harmed if they cut corners and skip a personal consultation.

For Roman, which has $3.1 million in risk financing, an online visit costs $15 and Sildenafil costs $2 for a 20mg tablet or $10 for a 100mg tablet. The brand name Viagra costs $63 according to the website, while generic Viagra in the 25, 50 or 100mg size costs $34.

You will find that sildenafil is supposedly prescribed for PAH or pulmonary arterial hypertension – not for erectile dysfunction. Others point out that prescribing a drug for pulmonary arterial hypertension can have a serious negative effect on the health of the patient.

DOCTORS RECOMMENDATIONS

Before taking Viagra or any other medication to treat erectile dysfunction, doctors recommend that lifestyle and other causes be investigated. For example, diabetes can be an underlying cause, as can heart disease, high blood pressure or relationship problems. Thus, studying all factors and promoting good health can avoid the need for Viagra.

Like any medication, Viagra is not free of side effects, including mild ones like headaches, hot flashes and blue vision. More serious side effects have also been observed, including very low blood pressure, heart attack and stroke.

So as you might expect, doctors do not rate online Viagra sellers very highly. Doctors feel that these other contributing factors, as well as general health, need to be investigated and a patient needs to be monitored.

MORE ABOUT PRICE FLUCTUATIONS

Price fluctuations are not unknown: When branded drugs become available in a generic version, the pharmaceutical industry applies all possible pricing strategies. Sometimes only the brand name medicine is on the “formulary”, the list your insurance company uses to limit the medicines available under your insurance plan.

It is also not uncommon to use an ‘off label’ drug, as would be the case with a drug for pulmonary arterial hypertension to treat erectile dysfunction. The use of beta blockers to combat stage fright is just one example. Here is a paper from Peoples Pharmacy, in which several others are described.

Sometimes the pharmacy benefit managers, the actors behind the scenes who buy drugs and deliver them to pharmacies, charge hidden fees that drive up prices.

Sometimes the manufacturer of a drug that is about to lose its patent reformulates the drug and claims that the new generic drug is not identical. There are a million different strategies to keep prices high.

This particular drug is interesting in this respect, as our caller noted, because so often it is not covered by insurance.

THE PROBLEM OF COUNTERFEITS ETC.

News reports of counterfeit Viagra and Sildenafil are widespread, perhaps because of the embarrassment factor: men may decide to order a drug online to avoid a visit to the doctor, but buying drugs online is something to approach with caution.

A solid source of information about drugs is The Peoples Pharmacy, an informative and nonsensical look at the world of drugs. You can also check out our page on saving on prescription drugs.

In the meantime, you may be interested in the bigger question: We can solve erectile dysfunction, but not osteoporosis, which affects mostly women. We also put the responsibility for birth control on women rather than men, and anyone who has ever taken birth control pills will tell you that there are unforeseen side effects, both physical and behavioural.

You probably knew this too, but depression affects more women than men – and we are still not able to deal with it in a meaningful way. Mood swings caused by hormones in birth control pills exacerbate this problem. To the unsightly picture of women’s health is added the fact that this nation has a very high maternal mortality rate compared to other developed countries.

And yet – erectile dysfunction can be solved for $1 or $3 or maybe $10. Or 80 dollars!