Today’s lesson on health care economics:
On GoodRx, a month’s worth of sildenafil 20 mg costs $17.25
On the same site, a month’s worth of sildenafil 25 mg costs $507.24
Does anyone buy the 25 mg version? You bet - I saw a patient who was on it yesterday (don’t worry; he’s since been switched over).
What’s going on here? Sildenafil has two FDA approvals - one, under the name “Revatio”, for hypertension. The other, under the name “Viagra”, for - well, you know.
The FDA only approved Revatio at doses of 5 and 20 mg, and only approved Viagra at doses of 25 and 100 mg. So sildenafil 20 mg has “Revatio” on the box and sildenafil 25 mg has “Viagra” on the box. Revatio is generic and dirt-cheap; Viagra is still on-patent and expensive.
But can’t people who want Viagra just buy Revatio?
Yes, totally. But the average patient doesn’t know this is going on. And the average doctor doesn’t really have any incentive to care because they’re not the one buying it (I’ve had patients who have asked their doctor to prescribe the cheaper version, and the doctor has refused because they want to do it the “proper” way). And I think it’s illegal for the insurance companies to insist, because technically the FDA only approved sildenafil 25 mg for erectile dysfunction but didn’t approve sildenafil 20 mg.
(also, some people are like “But I need a higher 50 mg dose of Viagra, and Revatio only goes up to 20 mg!” As the ancient rationalist proverb goes, have you tried thinking about the problem for five minutes?)