A Cost Analysis of Phosphodiesterase Type 5 Inhibitors in the United States.

OBJECTIVE: To perform a cost analysis of generic and brand-name PDE5 inhibitors at different dosages and pharmacies across the US.

METHODS: Using an all-payer retail pharmacy-claims database, we analyzed prescription drug data for three generic and six brand-name oral PDE5 inhibitors at different dosages across US chain and independent pharmacies in 2019.

RESULTS: We obtained cash price data from 60,186 pharmacies (35,976 chain and 24,210 independent). The nationwide mean cash price per unit (PPU) ranged from $8.6±5.2 (sildenafil 20mg at chain pharmacies) to $107.1±71 (Adcirca 20mg at independent pharmacies) equal to 1,145.3% difference. Chain pharmacies provided significantly lower average prices for one brand-name and six generic PDE5 inhibitors. Tadalafil PPU was cheaper at higher quantities, however PPU increased with quantity prescribed for sildenafil. Looking at the top 10 metropolitan statistical areas, the highest PPUs were observed for tadalafil (Cialis) 10mg and sildenafil (Viagra) 50mg in Atlanta ($67.4±8.7) and Los Angeles ($50.3±24.0), while New York ($9.7±2.6) and Miami ($27.9±16.4) had the lowest PPUs for tadalafil (Cialis) 5mg and sildenafil (Viagra) 100mg, respectively.

CONCLUSION: A substantial variability in PDE5 inhibitor cash prices exists across manufacturer, dosage, quantity, pharmacy type, and location. In addition, the pricing does not necessarily correlate with the regional socioeconomic factors. This highlights the importance of provider awareness and patient counseling on drug price including potentially assisting patients in identifying opportunities for cost savings.