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 common 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. "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. Markups for brand-name drugs facing generic pressure aren't a new phenomenon.

Generic Viagra: is sildenafil safe and effective?

When It Comes to Humongous Markups, Viagra Stands Tall Viagra isn't alone in boosting its price in response to competition. For nearly 3 decades, researchers have chronicled the "generic competition paradox": Drugmakers actually boost the prices of their brand-name medications when cheaper generics enter the market. The most likely brand-name drugs to do this are those with high name recognition and intense generic competition, Seoane-Vazquez said. (Viagra fits this description.) Other types of drugs are less likely to raise their prices in response to generics. These, he said, include drugs such as biologics with limited competition, drugs used in hospitals and physician offices, and drugs with relatively low name recognition such as some antibiotics.

Cialis lasts longer than Viagra but may have more side effects

In a bit of good news for consumers, the generic competition paradox phenomenon appears to be less common than it used to be, according to researchers with StoneTurn, a consulting firm. They examined 78 drugs whose patents expired from 2009 to 2020 and found that their prices tend to stabilize after generic equivalents appear and not go up at a fast clip. This marks a significant shift from the past, the researchers argue in a 2021 study published in the International Journal of the Economics of Business. They write: "We believe the results in our paper reflect the brand-name pharmaceutical companies' acknowledgement of the ever-changing competitive landscape and their attempt to moderate price increases in response to the ever-growing market presence of generics." "Its price did keep moving up even after the generic entry, with the annualized rate of change at 9.5% before generic entry and 15.4% afterwards," study co-author Yong Xu, a managing director at StoneTurn, told MedPage Today. The price markup of Viagra since it gained generic competition appears to be an outlier among ED drugs specifically and prescription drugs in general.

Fildena Super Active

Thirty tablets of a typical 5-mg dose of tadalafil, for example, cost as little as $11.05 in the generic form but jumps to at least $365.51 as brand-name Cialis, per GoodRx.com. (Both prices require coupons for discounts.) While that markup is hefty -- the brand-name is 33 times the price of the generic -- it's not in the league of Viagra's markup for a 30-day supplies of 100-mg pills. Eli Lilly and Company, the manufacturer of Cialis, didn't respond to questions from MedPage Today. Marsh, the director of research at GoodRx.com, said there's also notable demand for the brand-name versions of the thyroid drug levothyroxine and the blood thinner warfarin even though much-cheaper generics are available. Again, however, the markups aren't anywhere as near as extreme as Viagra's. "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. 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." There are some differences: Brand-name drugs may have different inactive ingredients than the equivalent generics, and they typically look different due to trademarks that protect their appearance. Among sildenafil pills, for example, only brand-name Viagra can be both blue and diamond-shaped.

Product	Dosage	Quantity + Bonus	Price
Viagra Oral Jelly	100mg	10 Sachets	46.36€ 44.15€
Viagra Generic	150mg	30 + 2 Pills	72.32€ 68.88€
Viagra Original	100mg	14 + 2 Pills	89.03€ 84.79€
Viagra Generic	100mg	360 + 10 Pills	330.21€ 314.49€
Viagra Generic	150mg	180 + 10 Pills	236.46€ 225.20€
Viagra Super Active	100mg	20 + 4 Pills	48.05€ 45.76€
Viagra Generic	150mg	10 Pills	36.73€ 34.98€
Viagra Soft Tabs	100mg	10 Pills	36.93€ 35.17€
Viagra Generic	100mg	120 + 6 Pills	149.50€ 142.38€
Viagra Generic	100mg	20 Pills	45.58€ 43.41€
Viagra Professional	100mg	60 + 2 Pills	146.74€ 139.75€
Viagra Original	100mg	64 + 4 Pills	264.15€ 251.57€
Viagra Oral Jelly	100mg	110 + 9 Sachets	284.63€ 271.08€
Viagra Oral Jelly	100mg	21 Sachets	78.66€ 74.91€
Viagra Generic	25mg	120 + 6 Pills	125.56€ 119.58€

There can also be variations in the bioavailability of a drug's active ingredient. It's not easy to understand exactly how much the typical customer pays for brand-name and generic sildenafil. For one thing, list prices don't truly represent the viagra daily amount that customers pay for drugs.

How do I store Sildenafil tablets?

Who is Sildenafil suitable for?

What are the serious side effects of sildenafil?

In 2020, Upjohn -- a unit of Pfizer that manufactured Viagra and other off-patent drugs -- merged with drugmaker Mylan to become a new firm called Viatris. It now makes both brand-name and generic Viagra. Viatris declined to explain its pricing and instead sent a statement noting it "offers both branded and generic options for patients taking this medication. .. We encourage patients to work with their healthcare professionals to determine the best treatment option for them." The company also noted that eligible patients can save on brand-name Viagra via a "savings card." The reverse of the Viagra pricing question is this: Why do men still insist on paying exorbitant prices for a brand-name drug when they could save hundreds or thousands of dollars a year? According to GoodRx.com, the cheapest price in the San Diego area for six tablets of 100 mg generic sildenafil is $9.47 at Ralphs supermarkets with a free coupon. The least expensive price for the equivalent amount of brand-name Viagra is $404.26 at all 10 pharmacy outlets listed with a free discount -- a markup of 42 times. When It Comes to Humongous Markups, Viagra Stands Tall Viagra isn't alone in boosting its price in response to competition. For nearly 3 decades, researchers have chronicled the "generic competition paradox": Drugmakers actually boost the prices of their brand-name medications when cheaper generics enter the market. The most likely brand-name drugs to do this are those with high name recognition and intense generic competition, Seoane-Vazquez said.

Viagra (sildenafil) for ED: a proven treatment to increase penile blood flow

Markups for brand-name drugs facing generic pressure aren't a new phenomenon. "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. 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.

What can I expect when my husband takes Viagra?

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." There are some differences: Brand-name drugs may have different inactive ingredients than the equivalent generics, and they typically look different due to trademarks that protect their appearance. Among sildenafil pills, for example, only brand-name Viagra can be both blue and diamond-shaped. There can also be variations in the bioavailability of a drug's active ingredient. It's not easy to understand exactly how much the typical customer pays for brand-name and generic sildenafil. For one thing, list prices don't truly represent the viagra daily amount that customers pay for drugs.

Viagra Soft Tabs

Pharmacies discount the prices of medications, and consumers can get coupons from a variety of sources such as pharmaceutical companies and GoodRx.com. To make things even more complicated, insurers may not cover ED drugs, and even if they do they're not likely to pay for expensive brand names when generics are available. One thing is clear: Viagra's markup is consistently high. According to GoodRx.com, the cheapest price in the San Diego area for six tablets of 100 mg generic sildenafil is $9.47 at Ralphs supermarkets with a free coupon. The least expensive price for the equivalent amount of brand-name Viagra is $404.26 at all 10 pharmacy outlets listed with a free discount -- a markup of 42 times. (Viagra fits this description.) Other types of drugs are less likely to raise their prices in response to generics. These, he said, include drugs such as biologics with limited competition, drugs used in hospitals and physician offices, and drugs with relatively low name recognition such as some antibiotics. In a bit of good news for consumers, the generic competition paradox phenomenon appears to be less common than it used to be, according to researchers with StoneTurn, a consulting firm. They examined 78 drugs whose patents expired from 2009 to 2020 and found that their prices tend to stabilize after generic equivalents appear and not go up at a fast clip. This marks a significant shift from the past, the researchers argue in a 2021 study published in the International Journal of the Economics of Business. They write: "We believe the results in our paper reflect the brand-name pharmaceutical companies' acknowledgement of the ever-changing competitive landscape and their attempt to moderate price increases in response to the ever-growing market presence of generics." "Its price did keep moving up even after the generic entry, with the annualized rate of change at 9.5% before generic entry and 15.4% afterwards," study co-author Yong Xu, a managing director at StoneTurn, told MedPage Today.

The global market for Viagra and sildenafil is highly competitive, influencing prices.
Patients should compare costs between different brands and generics to find affordable options.
Some online stores offer discounts during holidays, lowering sildenafil prices temporarily.
Generic sildenafil is often identical in effectiveness but at a fraction of the cost.
The cheapest Viagra options often come from emerging markets with looser regulations.
Buying directly from manufacturers or authorized sellers ensures authenticity and fair pricing.

The price markup of Viagra since it gained generic competition appears to be an outlier among ED drugs specifically and prescription drugs in general. Thirty tablets of a typical 5-mg dose of tadalafil, for example, cost as little as $11.05 in the generic form but jumps to at least $365.51 as brand-name Cialis, per GoodRx.com.

Cost for sildenafil varies globally, with cheaper options often available in India and South Asia.
Many online platforms sell Viagra in the $20-$40 range, offering discreet delivery options.
Generic sildenafil prescriptions might cost less with online consultation services.
Price comparison tools help find the best deals for Viagra or sildenafil in your area.
Buying from licensed pharmacies ensures quality but may be slightly more expensive.
Cheaper sildenafil options are often associated with less strict regulation and quality concerns.

(Both prices require coupons for discounts.) While that markup is hefty -- the brand-name is 33 times the price of the generic -- it's not in the league of Viagra's markup for a 30-day supplies of 100-mg pills.

Before Using

"I do have some patients who insist on the brand name because they believe that it works better than cheaper alternatives," said Pastuszak. "As you can imagine, this is difficult to prove," especially considering "the potential for a placebo effect." Seoane-Vazquez said the high price itself can be a draw: Customers might think "there must be something in the drug that costs $50 instead of 50 cents." And, he said, "drugs often fail to work as intended. When a brand drug fails, patients may think that the drug does not work and try other alternatives. When a generic drug fails, patients may think that something is wrong with the drug and ask to switch to the brand." He added that "brand names and higher prices are associated with value, and using expensive brands is a demonstration of wealth. So it is also possible that patients use the brand to demonstrate that they are wealthy." Viagra's worldwide revenue has dipped mightily since generics appeared, and the drug's unusual pricing strategy doesn't appear to be setting the world on fire for its new manufacturer. Eli Lilly and Company, the manufacturer of Cialis, didn't respond to questions from MedPage Today. Marsh, the director of research at GoodRx.com, said there's also notable demand for the brand-name versions of the thyroid drug levothyroxine and the blood thinner warfarin even though much-cheaper generics are available. Again, however, the markups aren't anywhere as near as extreme as Viagra's.

Pharmacy Chain	Price per 20 Tablets	Store Locations	Customer Rating
Walgreens	$300	50+	4.2/5
CVS Pharmacy	$290	40+	4.0/5
Chemist Warehouse	$280	80+	4.5/5

Thirty tablets of 50 mcg levothyroxine and 30 tablets of 5 mg warfarin cost as little as $4 at Walmart for consumers without insurance, per GoodRx.com. The brand-name equivalents of these typical doses cost at least $45.41 for Synthroid and $75.79 for Coumadin, respectively. Pfizer Spins Off Viagra, and the New Company Struggles Why is Viagra's price so astronomically high? "They're obviously doing it because they can," suggested Johns Hopkins Medicine primary care physician Stephen Sisson, MD, who told MedPage Today that he tries to talk his patients out of paying for unnecessarily expensive brand-name drugs. MedPage Today sent a series of questions about the drug's pricing to the new maker of Viagra. In 2020, Upjohn -- a unit of Pfizer that manufactured Viagra and other off-patent drugs -- merged with drugmaker Mylan to become a new firm called Viatris. It now makes both brand-name and generic Viagra. Viatris declined to explain its pricing and instead sent a statement noting it "offers both branded and generic options for patients taking this medication. .. We encourage patients to work with their healthcare professionals to determine the best treatment option for them." The company also noted that eligible patients can save on brand-name Viagra via a "savings card." The reverse of the Viagra pricing question is this: Why do men still insist on paying exorbitant prices for a brand-name drug when they could save hundreds or thousands of dollars a year? "I do have some patients who insist on the brand name because they believe that it works better than cheaper alternatives," said Pastuszak. "As you can imagine, this is difficult to prove," especially considering "the potential for a placebo effect." Seoane-Vazquez said the high price itself can be a draw: Customers might think "there must be something in the drug that costs $50 instead of 50 cents." And, he said, "drugs often fail to work as intended. When a brand drug fails, patients may think that the drug does not work and try other alternatives. When a generic drug fails, patients may think that something is wrong with the drug and ask to switch to the brand." He added that "brand names and higher prices are associated with value, and using expensive brands is a demonstration of wealth.

Viagra prescription FAQs

Are you currently using Sildenafil (Viagra, Revatio)?

"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.

Tadalis Sx

From December 2017 to June 2021, the list price for six tablets of 100 mg of generic sildenafil (the most common 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. "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. So it is also possible that patients use the brand to demonstrate that they are wealthy." Viagra's worldwide revenue has dipped mightily since generics appeared, and the drug's unusual pricing strategy doesn't appear to be setting the world on fire for its new manufacturer.

The Real Cost of Erectile Dysfunction Treatment