Location Matters When It Comes to Saving on Erectile Dysfunction Treatment

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A new analysis by GoodRx Research, in collaboration with the University of California, San Francisco (UCSF), highlights how costs of phosphodiesterase type 5 (PDE5) inhibitors, used for erectile dysfunction (ED), can vary by as much as 1,145% in the U.S. The research was published in Urology.

ED affects up to 30 million people in the U.S. Oral medications like sildenafil (generic Viagra) and tadalafil (generic Cialis) are the most common treatment for ED. These medications, classified as PDE5 inhibitors, have been shown to be equally safe for ED treatment.

But despite the effectiveness of PDE5 inhibitors, nearly half of patients stop using them within a year. Affordability is a top concern, as poor insurance coverage can lead to high out-of-pocket costs for patients.

Both patients and providers should be aware of the factors associated with higher costs for ED treatment. Below are key findings from our study that outline some of these factors.

PDE5 inhibitor costs vary by location

We investigated ED medication cash prices in different parts of the U.S. Looking at the 10 largest metropolitan areas, we found that the cost of ED treatment varied across locations with different population characteristics like income, purchasing power, and health insurance coverage.

The map below shows the range of average cash prices for sildenafil in the 10 largest metropolitan areas. For the 50 mg and 100 mg dosages, Miami had the cheapest average prices for sildenafil, while Houston and Los Angeles were the most expensive.

Houston also had the largest population share that was uninsured (18%) out of the 10 metro areas. This means that potentially more patients there are exposed to higher prices for ED treatment.

The 20 mg dosage of sildenafil had different patterns in pricing. New York had the highest average cash prices, while Atlanta was the cheapest. The difference in geographic pricing trends may be due to the 20 mg dosage being used to treat pulmonary hypertension, while being prescribed off-label for ED.

Geographic pricing patterns also differ across medications. As the map below shows, average cash prices for tadalafil followed different trends than sildenafil.

Across all dosages, Atlanta had the highest average cash prices for tadalafil. This was despite the city having the lowest cost of living based on regional price parity among the 10 metro areas (regional price parity indicates how much local prices are above or below the national average).

In contrast, New York and Los Angeles had the highest cost of living but the lowest average cash prices for tadalafil 5 mg and 10 mg, respectively. This suggests that cash prices for ED treatments are not necessarily associated with local price levels.

PDE5 inhibitor costs vary by medication and pharmacy

While all ED prescription medications are safe and effective, prices differ across manufacturers, dosages, and quantities filled. The table below shows average cash prices for different PDE5 inhibitors at both chain and independent pharmacies.

The cash price is the price paid without insurance. Patients may pay cash for their ED medications if they don't have insurance, their insurance doesn't cover the medication, or they are in the deductible phase of their insurance.

As the table shows, cash prices for PDE5 inhibitors vary widely by medication, dosage, and manufacturer. The cheapest ED medication costs $8.60 per 20 mg tablet of sildenafil, while the most expensive costs $107.10 per 20 mg tablet of Adcirca - a 1,145% difference.

Generic and brand-name status of the manufacturer is one important factor in cash price. For example, one 50 mg tablet of sildenafil costs $43.70, on average, at chain pharmacies. By comparison, the brand-name version, Viagra, costs over twice as much ($89.10) for the same dosage at chain pharmacies.

Even for the same manufacturer, dosage can make a difference in cost. For example, the average cash price of tadalafil at chain pharmacies increased from $10.20 per 5 mg tablet to $60.20 per 10 mg tablet. That's nearly a 5-fold increase in price for only double the dosage.

Cash prices differ by pharmacy setting as well. For one brand-name medication and six generic medications, chain pharmacies offered significantly cheaper cash prices compared to independent pharmacies.

Summing it all up

The cost of ED treatments vary considerably by retail pharmacy type, manufacturer, dosage, and quantity. PDE5 inhibitor prices also don't show clear patterns in regard to regional socioeconomic factors like income, insurance coverage, and price level.

This analysis highlights the importance of provider awareness and patient counseling to help identify the most affordable medication regimen for ED.

Read about our study methods and all of our findings in the full research paper published in Urology.

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