How to save on ED medication: generic Viagra and Cialis

ED is common, and treatable

The National Institutes of Health estimates that erectile dysfunction affects 30 million to 50 million men in the United States. It becomes more common with age: about 40% of men are affected by age 40 and about 70% by age 70 (NIDDK). Diabetes, heart disease, obesity and some medicines, including some blood pressure medicines and antidepressants, can raise the risk (NIDDK).

Start with a doctor. NIH says not to order an ED medicine online before talking with a health care professional (NIDDK). Treatment can include lifestyle changes, counseling, changing a medicine that causes ED, pills, and other options such as injections or vacuum devices (NIDDK).

Generic sildenafil and tadalafil

• Sildenafil is sold as the brand Viagra for ED. The same drug is sold as Revatio and Liqrev for pulmonary arterial hypertension (PAH) (MedlinePlus). It’s usually taken about an hour before sex, and no more than once in 24 hours (MedlinePlus).
• Tadalafil is sold as Cialis for ED and for symptoms of an enlarged prostate (BPH), and as Adcirca for PAH (MedlinePlus). Depending on what your doctor prescribes, it may be taken every day or as needed (MedlinePlus).
• Generic timing. The FDA approved the first generic of Cialis, Teva’s tadalafil tablets, on May 22, 2018 (FDA).

The FDA says approved generics work the same way as the brand and usually cost less, and that prices tend to fall as more generic makers enter the market (FDA).

What insurance and Medicare cover

• Medicare Part D. By law, Part D plans can’t cover drugs used to treat erectile dysfunction. The same drugs may be covered for other FDA-approved uses, such as PAH (CMS).
• Private and Marketplace plans. Coverage varies. Check your plan’s drug list. If your doctor thinks a drug is medically necessary and your plan won’t cover it, you can ask for an exception (HealthCare.gov).
• Paying cash. When a drug isn’t covered, a discount card can lower the cash price at many pharmacies. Medicare.gov notes that drugs bought with a discount card instead of your plan don’t count toward your plan’s out-of-pocket limit (Medicare.gov).

Use it safely

• Don’t take sildenafil or tadalafil with nitrate medicines such as nitroglycerin, or with street drugs called poppers. The combination can cause a dangerous drop in blood pressure (MedlinePlus, MedlinePlus).
• Tell your doctor about all your medicines. Tadalafil interacts with many drugs, including alpha blockers (MedlinePlus).
• Use only one sildenafil or tadalafil product at a time (MedlinePlus, MedlinePlus).
• Get medical help right away for an erection that lasts more than four hours, or for sudden vision or hearing loss (MedlinePlus, NIDDK).

Avoid fake and hidden-drug products

The FDA warns that many products sold for sexual enhancement or ED, such as male enhancement supplements and stamina pills, are likely to contain dangerous hidden ingredients. They are sometimes falsely sold as dietary supplements or all-natural treatments, and they can lead to severe health problems and hospitalization. A product that isn’t on FDA’s warning list isn’t necessarily safe (FDA).

If you buy online, the FDA says to use a state-licensed pharmacy that requires a valid prescription and has a licensed pharmacist to answer questions (FDA BeSafeRx).

More ways to lower the cost

• Ask your pharmacist for the cash price and the discount card price, and compare a few pharmacies.
• No insurance? HRSA-funded health centers offer care on a sliding fee based on income. Find one near you.

See also prescription discount cards and prescriptions without insurance.