Brand Viagra 100mg

In a weird paradox, it’s never been cheaper — and more expensive — for men to treat themselves with sildenafil (Viagra), the mainstay of erectile dysfunction therapy. And herein lies a tale about the bizarro world of drug pricing.

Generic versions of sildenafil cost as little as 44 cents per typical 50-mg dose in the U.S. when 30 pills are purchased, according to GoodRx.com. At that price, the doses needed to power a month’s worth of daily intimate encounters add up to just $13.20, less than a Chipotle steak burrito with guacamole and a drink.

But equivalent brand-name Viagra pills cost at least $67.12 each, or $2,013.70 for 30. That’s a remarkable markup of over 150 times the generic price, even though the pills share the same active ingredient and work the exact same way.

A MedPage Today investigation found that Viagra is perhaps the most extraordinary example of a curious phenomenon in the world of drug pricing — brand-name medications whose prices go up despite the arrival of stiff competition from much-cheaper generics.

This isn’t the way competition in capitalism is supposed to work, and it’s hardly healthy for consumers. But some pharmaceutical companies are banking big-time on brand-name loyalty and ignorance about generics, and no one is going to tell them to knock it off.

“Companies can decide the price of drugs in the U.S. private sector without any constraints,” Enrique Seoane-Vazquez, PhD, a professor of pharmacy who studies drug pricing at Chapman University in Irvine, California, said in an interview with MedPage Today. “We may need public health campaigns explaining the value of generic drugs so patients have information and can decide if they want to expend thousands of dollars out-of-pocket to get the brand drug instead of the low-cost generic.”

Viagra: Still the ED Leader After All These Years

Sildenafil entered the U.S. market as Viagra in 1998 and instantly revolutionized impotence care by giving men a convenient alternative to less-than-appealing erectile dysfunction (ED) treatments like penis pumps, injections, and implants. The little blue pill became a household name thanks to celebrity endorsements, TV commercials, and the world’s most famous side effect. (Sorry, gentlemen, a four-hour erection isn’t all it’s cracked up to be.)

Nearly a quarter-century later, sildenafil has spawned a handful of competitors, notably tadalafil (Cialis) and vardenafil (Levitra), but it remains the undisputed king of ED care in the U.S., according to 2018 to 2019 numbers.

“Viagra is still often the first drug prescribed because everyone knows about it, and even primary care docs are comfortable writing it. Also, the evidence in the literature largely supports it being the strongest and most efficacious” of the main ED drugs, University of Utah urologist Alexander Pastuszak, MD, PhD, told MedPage Today. “There are strong considerations for Cialis as well, but it’s less popular because fewer physicians and patients really know how to use it.”

Patent expiration, the perennial scourge of brand-name drug manufacturers, came for Viagra in the late 2010s. Pfizer and Teva Pharmaceuticals began selling generic forms of sildenafil in late 2017, and other companies started offering generic products the following year. That’s when the world shifted for patients.

From December 2017 to June 2021, the list price for six tablets of 100 mg of generic sildenafil (the most commonly prescribed amount) fell by 98% from $265 to $4, according to an analysis provided by GoodRx.com. Over that same time, the average list price for the equivalent doses of Viagra grew by 27% from $369 to $467.

“We’re still seeing spikes with Viagra every year, while sildenafil has plummeted in price,” GoodRx.com director of research Tori Marsh, MPH, told MedPage Today.

Physicians are mystified. “I have no idea why there continues to be that large price gap. There is just no good reason,” endocrinologist Bradley Anawalt, MD, chief of medicine at the University of Washington Medical Center, told MedPage Today.

Meet the ‘Generic Competition Paradox’

Markups for brand-name drugs facing generic pressure aren’t a new phenomenon. In fact, they’re standard. “The idea is that once a generic enters the market, the prices of the generic go so low in comparison with the brand that it doesn’t make sense for the brand to compete based on price,” Seoane-Vazquez said.

This is why shelves are filled with competing over-the-counter products that are essentially the same except one costs more and has a familiar name attached — Bayer, Tylenol, Afrin, Metamucil. The list goes on.

On grocery shelves, the big difference from pharmaceuticals is that no one requires low-priced supermarket brands to taste the same as Ragu pasta sauce or Kellogg’s Corn Flakes. In contrast, equivalent brand-name and generic drugs are mandated by law to be identical — mostly. As the FDA puts it, “a generic medicine is the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, as well as in the way it is taken and should be used.”