Erectile Dysfunction Medications - Costs and Effects of Those Costs
Reasons why the costs of brand-name erectile dysfunction (ED) medications are so expensive include the fact that insurance companies are increasingly not covering the medications, there is a lack of price transparency, and the "evergreening" patent process keeps drug prices high. Men who cannot afford brand-name ED medications often turn to the Internet for cheaper alternatives such as fake Viagra, generic ED medications, and herbal supplements.
Insurance Does Not Cover ED Medications
- In many cases, ED medications are expensive because Medicare and many private insurers do not cover them.
- Unless ED drugs are used to treat a different condition approved by the FDA, Medicare Part D, which is the prescription component of Medicare, does not cover them.
- As an example, Medicare may approve the use of sildenafil (generic Viagra) for the treatment of pulmonary arterial hypertension, but it would not be covered to treat erectile dysfunction.
- Private insurers often follow Medicare guidelines in what they will cover and in the case of ED medications, they have reasoned that "drugs to treat sexual dysfunction are lifestyle-related rather than medically necessary."
- ED medications can cost hundreds of dollars per month, which is often unaffordable for Americans, particularly older people who are on fixed incomes. As an illustration, 10 pills of 50 mg Viagra can cost as much as $600 and even eight Vagifem pills can reach over $200.
- Even generic versions of ED medications can be expensive, especially if insurance does not cover any portion of the cost.
Lack of Price Transparency
- The cost of ED medications does not follow normal economic patterns in that typically, when competition is introduced to the market, the price of the original goes down.
- Instead, with ED medications, when one company raises its prices, other companies are following suit, making the drugs more expensive across the board rather than driving costs down.
- A major reason for this is that insurance coverage masks the true cost of the drugs so people do not realize how much they really are.
- As stated in the Houston Chronicle, "When copays are fixed, consumers have no incentive to use less expensive drugs, and manufacturers cannot gain market share by charging less... Simply stated, when patients use insurance to pay for drugs, prices go up."
- Therefore, even when insurance covers part of or the full cost of a specific ED medication, patients are only exposed to their portion of the cost, which only changes if their insurance plan changes. They do not notice price increases, nor do they care if they increase unless they lose insurance coverage.
- According to the Houston Chronicle, a solution to this problem would be to buy prescription drugs directly from pharmacies. When consumers have to pay the full amount for drugs, they become more discerning and will likely purchase less expensive alternatives.
- According to Eli Lilly, manufacturer of the ED medication, Cialis, drugmakers tend to raise the price of their medications as a patent becomes close to expiration.
- A spokesman for Eli Lilly stated, when medications go off-patent, as with Cialis, drug manufacturers often increase the price to "reflect both the limited time of patent life when an innovator can receive a fair return for their significant R&D costs, as well as the much longer time a generic is available at a dramatically lower cost."
- However, the U.S. drug patent system can allow manufacturers to extend their patent exclusivity protections in a process called "evergreening," which means the drugs remain expensive well past the original patent expiration date.
- A study found that 80% of the 100 best-selling drugs in the U.S. "extended their exclusivity protections at least once, and 50% extended their patents more than once."
- The patent system creates a monopoly during the protection period and "in the absence of genuine competition in the U.S. prescription drug market, monopolies are yielding reckless pricing schemes and prohibitively expensive drugs for Americans."
- When men are unable to afford brand-name erectile dysfunction medications, they often turn to the Internet to buy similar products online.
- Even in the UK, where sildenafil is available over-the-counter for about £4 per pill, men still want a deal and would rather pay for a cheaper online version, which can cost as little as £1 per pill.
- According to the Daily Mail, "The black market in fake or unlicensed erectile dysfunction pills has soared in the UK in recent years," which indicates that even though access to ED medication is no longer a problem, the cost still is.
- The situation is no different in the U.S., as Dr. Damon E. Davis, a urologist at Mercy Medical Center, notes, "Despite the medications being on the market for over a decade, the costs have not decreased significantly... Additionally, insurances are increasingly refusing coverage for medications to treat erectile dysfunction. The financial burden this places on patients who are sometimes desperate makes it no surprise that some look toward cheaper, illicit sources."
- New startups such as Hims and Roman Health Medical are marketing themselves as an alternative to big pharmaceuticals, but even their costs are marked up. For instance, Hims charges $3 per 20 mg sildenafil pill and Roman charges $2 per pill. However, the cost to pharmacies is $0.15 per pill.
- Patients who turn to these startups "may not realize they could have gotten better deals" by using discount programs or coupons."
- Additionally, Hims and other startups are targeting the "same older customers that the brand-name pharmaceutical companies once sought," which means more men who have trouble getting insurance to cover ED medications may turn to these companies because of advertising.
- Direct-to-consumer companies like Hims and Roman Health Medical are "leading to an increase in purchasing medications online," so much so that even Pfizer, the manufacturer of Viagra and a generic form offers consumers the ability to purchase these medications directly from its website.
- Men also turn to generics when they are unable to afford brand-name ED medications.
- Between December 1, 2018 and January 31, 2019, 65% of ED medication prescriptions filled on GoodRx were for Viagra or its generic version. Of the prescriptions for Viagra or its generic, 90% were for the generic and just 10% were for the brand-name.
- According to Tori Marsh, data and content manager at GoodRx, "The data can’t explain the reason behind why people take the generic over the brand, or vice versa... but since generic Viagra is more affordable than the brand it’s likely that cost is a factor here."
- Moreover, if insurance companies are going to cover ED medications at all, they will likely require the generic version be prescribed rather than the brand-name to help hold down costs.
- Non-prescription, herbal supplements are also an alternative to brand-name ED medications, which may also be less expensive since they do not require a doctor's visit to obtain.
- Dr. Daniel Shoskes, a urologist at the Cleveland Clinic, stated that his male patients "ask him about so-called herbal supplements all the time," but he warns them that "self-medicating erectile dysfunction is not a good approach."