A MedPage Today investigation found that Viagra is perhaps the most extraordinary example of a curious phenomenon in the world of drug pricing -- brand-name medications whose prices go up despite the arrival of stiff competition from much-cheaper generics. This isn't the way competition in capitalism is supposed to work, and it's hardly healthy for consumers. But some pharmaceutical companies are banking big-time on brand-name loyalty and ignorance about generics, and no one is going to tell them to knock it off. "Companies can decide the price of drugs in the U.S. 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.

Packaging Type Description Common Usage
Blister Packs Sealed plastic and aluminum foil Single-dose tablets
Bottles Plastic bottles with caps Refill and multiple doses
Foil Wraps Individual foil-wrapped pills Travel or discreet use
Cartons Cardboard boxes containing blister packs Retail packaging

(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.

  • Clear blister with rounded edges
  • Label with QR code linking to info
  • Child-resistant blister designs
  • Packaging with safety warnings
  • Eco-friendly biodegradable materials
  • Easy-open blister overlays
  • Printed batch and lot numbers
  • Light-resistant blister packaging
  • Sealed cartons for bulk orders
  • Transparent packaging to inspect contents

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.

12. Viagra - Clinical Pharmacology

(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. 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.

2.1 Dosage Information

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.

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

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. 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.

Country/Region Packaging Type Regulatory Info
USA Bottle + blister pack FDA requirements
European Union Blister packs, cartons EMA standards
Asia Small blister packs, foil wraps Regulations vary by country
Australia Child-resistant bottles TGA compliance

There is just no good reason," endocrinologist Bradley Anawalt, MD, chief of medicine at the University of Washington Medical Center, told MedPage Today.

Product Dosage Quantity + Bonus Price
Viagra Generic50mg270 + 8 Pills198.48€ 189.03€
Viagra Generic25mg60 + 4 Pills71.99€ 68.56€
Viagra Generic100mg180 + 8 Pills199.37€ 189.88€
Viagra Generic150mg120 + 8 Pills177.58€ 169.12€
Viagra Generic50mg90 + 6 Pills107.37€ 102.26€
Viagra Generic25mg30 + 4 Pills47.97€ 45.69€
Viagra Generic25mg360 + 10 Pills213.68€ 203.50€
Viagra Generic100mg20 Pills45.58€ 43.41€
Viagra Super Active100mg10 Pills28.76€ 27.39€
Viagra Generic100mg60 + 4 Pills96.36€ 91.77€

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

PRINCIPAL DISPLAY PANEL - 25 mg Tablet Bottle Label

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. When It Comes to Humongous Markups, Viagra Stands Tall Viagra isn't alone in boosting its price in response to competition.

12.1 Viagra Mechanism of Action

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 viagra daily 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. 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.

5.8 Effects on Bleeding

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. 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. "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. 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 amount that customers pay for drugs.

16. How is Viagra supplied

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 viagra cream facing generic pressure aren't a new phenomenon.

7.1 Nitrates

"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.

5.3 Effects on the Eye

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 amount that customers pay for drugs. Pharmacies discount the prices of medications, and consumers can get coupons from a variety of sources such as pharmaceutical companies and GoodRx.com. 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. 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 viagra daily likely brand-name drugs to do this are those with high name recognition and intense generic competition, Seoane-Vazquez said.

Read next

"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." (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.

  • Printed foil backing on blister
  • Vacuum-sealed packaging for freshness
  • Digital print of batch number
  • Recyclable print materials
  • Secure blister with snap fit
  • Minimalist design for branding
  • Labelling indicating storage temperature
  • User-friendly opening system
  • Child-resistant blister design
  • Packaging ensuring product integrity

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.

  • Tamper-proof blister packaging
  • High-visibility expiration date
  • Color-coded packaging for strength
  • Blister tray with pop-out tablets
  • Anti-counterfeit serial numbering
  • Compact, portable blister pack
  • Packaging made from recycled plastic
  • Moisture-proof foil backing
  • Clear labeling for patient instructions
  • Batch tracking labels on packaging

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. 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. 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.

COUNTERFEIT MEDICATIONS CAN BE DANGEROUS

A MedPage Today investigation found that Viagra is perhaps the most extraordinary example of a curious phenomenon in the world of drug pricing -- brand-name medications whose prices go up despite the arrival of stiff competition from much-cheaper generics. This isn't the way competition in capitalism is supposed to work, and it's hardly healthy for consumers. But some pharmaceutical companies are banking big-time on brand-name loyalty and ignorance about generics, and no one is going to tell them to knock it off. "Companies can decide the price of drugs in the U.S. 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.

2.4 Dosage Adjustments Due to Drug Interactions

"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.

Use In Specific Populations

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. .. 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."