Viagra lost patent protection this year, and in a feeding frenzy, firms selling its generic equivalent (sildenafil citrate) are angling for a slice of Pfizer’s 2 billion dollar per year pie. There are a dizzying assortment of prices, from Pfizer’s list price of $65 per 100 mg Viagra pill, to $7 for the generic equivalent (a 920% difference!). The combination of a high list price, different insurance coverages, discounts, and copay and cash option coupons creates a confusing array of choices. Pork belly futures have less complex price movement. I’ll provide a guide to purchasing Viagra and sildenafil, but first some amusing history.

Viagra is now off-patent and generic versions are available for $7 per dose. Click To Tweet

Viagra was a pharmaceutical, cultural, and economic phenomenon when it debuted in 1998. Rogaine and Claritin, with Cole Porter singing “Blue Skies,” were the first drugs to use Direct to Consumer (DTC) advertising. However the Pfizer juggernaut, including inventing the diagnosis “Erectile Dysfunction,” using Senator Bob Dole as spokesman, and presenting young, healthy-appearing men with the surprising need to “talk to their doctors” (nod, nod, wink, wink) was a sensation. They highlighted the extremely rare complication of prolonged erections (only 1 per 50,000 prescriptions) as a major focus. Even now there are perfectly functioning 20-year-olds stealing their fathers’ Viagra in hopes of experiencing such an event. Former House Speaker John Boehner’s 12th-term reelection opponent aired a TV ad stating, “If you have a Boehner (Pronounced “boner”) lasting more than 23 years, call your doctor immediately.”

Viagra and its competitors, Cialis and Levitra, became principal advertisers on NFL football broadcasts. Their success in DTC advertising attracts 6 billion dollars annually, including other drug companies and personal injury lawyers.

The discovery of Viagra’s erectile properties was an accident. In 1992 Pfizer started a trial of sildenafil citrate, the active ingredient in Viagra, to treat hypertension and heart failure. The drug was a complete bust for hypertension or heart failure. It was about as effective as a sugar pill. However, the patients, Welsh miners in the town of Merthyr Tydfil, refused to return the sildenafil citrate when the trial concluded. The local physician supervising the trial reported to Pfizer that the side effects were limited to indigestion, back pain… and erections. Erections? Hmmm?

Viagra earned more than one billion dollars in its first year and has earned over 30 billion dollars to date. Solvay pharmaceuticals, eager to have a piece of the pie, falsely claimed testosterone should be evaluated in all men with erectile dysfunction and “deficiencies” remedied with their overpriced drug Androgel. They launched their own wildly successful DTC “Low-T” DTC campaign. While Pfizer was never penalized for its overestimate of erectile function (40% of men over age 40 is too high), Solvay, laughing all the way to the bank, paid a fine of $450 million dollars to the FDA while making billions on Androgel.

Viagra earned more than one billion dollars in its first year and over 30 billion dollars to date. Click To Tweet

Testosterone does improve erectile dysfunction by increasing libido, reducing obesity, and improving diabetes. But the principal cause of erectile dysfunction is not testosterone deficiency. Vascular diseases, diabetes, obesity, neurologic disorders, prescription medications, tobacco use, alcoholism, sleep disorders, and prostate disease all contribute to erectile dysfunction. The unique effect of testosterone is to increase libido, without which, even healthy men taking Viagra fail sexually. In comparison with Viagra, however, the bulk of studies conclude that testosterone improves libido a lot, but only improves erectile function a little.

The principal cause of erectile dysfunction is not testosterone deficiency — it’s vascular disease. Click To Tweet

There are two supplements that provide relatively consistent improvement in erectile function. Viagra works by blocking the breakdown of nitric oxide, a messenger protein that improves blood flow to the penis. Both arginine and l-citrulline increase the supply of nitric oxide, also improving erectile function, but with a less powerful effect than Viagra. However, arginine and l-citrulline are metabolized over many hours, and in some studies, are reported to prolong erections. Like all supplements, you should consult your physician.

Here are (affiliate) links to help you evaluate these supplements for yourself:

The supplements arginine and l-citrulline can extend erections without a prescription. Click To Tweet

 

Welcome to the Wild West of Viagra Pricing

The list price for brand name Viagra is still $65 per pill. The active ingredient in Viagra is sildenafil citrate, which comes 20 mg tablets. A 100 mg Viagra pill has the same amount of sildenafil citrate as five 20 mg sildenafil tablets. Below is a table showing how much variation there in prices on just one day in May 2018. These prices can change day to day, and, indeed, even from the time a pharmacist quotes a price on the phone to when he or she actually runs the order through the computer. These numbers come from website Goodrx. There are many others — Google search “pharmacy discount coupon card” returned 18 million hits.

 

Comparison of Drug Store Chain Prices

Drug StoreMedicationAmountList Price TotalEquivalent SildenafilGoodrxCoupon Total
WalgreensViagra6 Pills =600 mg$3905 x 20 mg x 6 =100 mg$29.15$174.90
CVSViagra6 Pills =600 mg$288Equivalent$31.68$190.80
Stop and ShopViagra6 Pills =600 mg$390Equivalent$16.66$99.96

 

A more Detailed Example using Costco

Blue Pill ViagraBlue Pill Viagra6 Pills =600 mg$442
Generic White Pill ViagraGeneric White Pill Viagra6 Pills =600 mg$183
SildenafilSildenafil5 x 20 mg x 6 =100 mg$34.49
SildenafilGoodrx Coupon5 x 20 mg x 6 =100 mg$26.70
SildenafilActual TransactionMember Price$24.87

 

I have returned to the website several times and made calls to the same pharmacies. In each instance, many of the published prices are different than the actual price the pharmacist discussed with me. Caveat Emptor.

However, the coupon market has produced yet a potential new piece of Viagra humor. I am not certain that WatertreeHealthCards.com realized that by creating an alliance with the Make A Wish foundation to donate $.50 for every use of their card, they created a unique circumstance. Imagine some male of the species, rushing to a pharmacy on Friday night, holding this card in his hand, and indeed, making a wish! And supporting an excellent cause as well.

make a wish viagra discount card

Imagine it is Friday night, and some hyperventilating male of the species rushes to his pharmacy on Friday night, handing his Make A Wish prescription discount card to his pharmacist, while, indeed, making a wish! And supporting an excellent cause as well.

All joking and economic excesses aside, Viagra brought to light the issue of male impotence, which had been a silent epidemic, and provided a solution for half of men who previously had no solution. It added sexual activity as a measure of physical and mental well-being and raised consciousness about male and female sexuality at older ages.

 

James Katz MD

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