Variability in Prices for Erectile Dysfunction Medications—Are All Pharmacies the Same?

Abstract

Background Variability in prices of medications is a well-known phenomenon; however, this variability has not been quantified in the realm of erectile dysfunction (ED) medications. ED medications are ideal for this quantification, because they are often not covered by insurances; therefore, the cost is the most direct reflection of price variability among pharmacies as they affect the patients. Aim To evaluate the variability in cash prices for phosphodiesterase type 5 inhibitors (PDEIs) for ED. We also evaluated whether certain types of pharmacies consistently offer better pricing than others, and whether there was any correlation with demographic factors. Methods 331 pharmacies were contacted within a 25-mile radius of our institution to obtain the cash price for 4 commonly used ED medications with prespecified doses. After exclusion, 323 pharmacies were categorized as chain, independent, wholesale, or hospital-associated. Cash prices for the specified medications were evaluated. In addition, we identified demographic and socioeconomic factors to determine if these had an impact on median drug pricing within each zip code. Main Outcome Measure The main outcome was the cost for patients to fill each prescription. Results Independent pharmacies provided the lowest cost for 3 of 4 of the PDEIs. The largest price difference for 10 tablets of 100 mg sildenafil between all pharmacies was 38,000%. The median cost difference between independent pharmacies and chain pharmacies for sildenafil was >900%, and >1,100% for independent pharmacies vs hospital-associated pharmacies. Demographic and socioeconomic factors had no impact on the cost. Clinical Implications Our goal is to promote patient counseling among practitioners and to empower patients to shop for the best prices for their medications. Strength and Limitations A strength of the study is the large cohort that was surveyed; however, a weakness is that the large majority of the cohort was comprised of chain pharmacies. Mail pharmacies could not be evaluated as they required a valid prescription before offering prices. Conclusion The drastic differences in cash prices for the PDEIs give us an insight into the variability and cost-inflation of medications in the United States. These patterns hold true for other essential medications as well, and improved transparency will allow patients to make informed decisions when choosing where to purchase their medications. It may also encourage certain pharmacies to provide medications at more affordable prices.

Characteristics of men who use direct-to-consumer men’s health telemedicine services

“…DTC service users were also equally likely to have seen a physician in the prior year, indicating the presence of an established patient-physician relationship that could have been leveraged for men’s health care. Instead, these men opted for care through a DTC platform despite the potentially higher cost of medications compared to traditional prescribing routes or coupon sites [ 18 ]. This may be explained by the perceived savings of DTC services, as many companies advertise comparable medication costs, but often charge additional consultation, membership, and shipping fees.…”

Comparison of Discounted and Undiscounted Cash Prices for Cardiovascular Medications by Type of US Community Pharmacy

“…16 Accordingly, Mishra et al showed that undiscounted cash prices for four commonly used erectile dysfunction medications were the highest at chain pharmacies. 17 As for brandname CV medications, the GoodRx coupons appear to offer only marginally lower prices compared to undiscounted cash price.…”

“…Independent pharmacies may offer patients the most affordable cash prices without any specific discount coupons. 16,17 Aurora et al showed that prices with GoodRx coupons were comparable with cash undiscounted prices at independent pharmacies, whereas, Luo et al found independent pharmacies to have significant price variability and higher average prices on the GoodRx platform. 7 Anecdotally, independent pharmacies may refuse to accept a GoodRx coupon because the company charges the pharmacies an exorbitant processing fee that often results dispensing prescription at a loss.…”

A Comparison of Pharmaceutical Prices for Generic Erectile Dysfunction and Benign Prostatic Hyperplasia Medication in 2 Socioeconomically Disparate New York City Neighborhoods

“…13,14,22e24 However, our study is the first to identify significant price reductions in lower income neighborhoods. Mishra 13 and Theisen 14 et al identified significantly higher cash prices for ED and BPH medication at chain pharmacies in the Cleveland and Pittsburgh areas, respectively. However, no prior study has focused on socioeconomically disparate neighborhoods such as UES and EH.…”

“…12 Previous studies have identified significant variations in the cost of generic medications, reporting increased prices at chain pharmacies compared to independent pharmacies for ED and BPH medications. 13,14 Other studies, however, have shown contrary evidence that independent pharmacies offer higher prices for prescriptions, 15 and that higher pharmaceutical prices may be associated with lower socioeconomic neighborhoods, 16 suggesting a need for further evaluation of these trends. No study has focused on specific urban neighborhoods with significantly different median household incomes.…”