Why is the price for erectile dysfunction drugs so high?

Q: Drugs for erectile dysfunction are all extremely expensive. Are their prices being fixed, as I suspect? The price has steadily increased to about $60 a pill. And the prices are virtually the same for each brand-name drug. This has been the case since three ED drugs became available. This can’t be by coincidence!

I’ve tried to interest my congressmen and senators about this, but have had no response whatsoever. Can you spur a congressional investigation?

A: Drugs for erectile dysfunction are indeed pricey. A single 10-mg dose of Cialis (tadalafil) costs about $60. Levitra (vardenafil) is also nearly $60 a pill. As you have noted, brand-name Viagra (sildenafil) is in the same ballpark. The generic version is substantially less expensive, however.

We have no way of determining how drug companies adjust their prices. Competition is supposed to lead to lower prices, but it doesn’t seem to work that way for brand-name prescription drugs.

Generic drugs are not immune. Last spring, 45 states and the Department of Justice uncovered a bid-rigging scheme that may have cost consumers and businesses a billion dollars. The prosecutors found evidence regarding the antibiotic doxycycline, but other generic drugs probably also were affected.

Q: My father is 76 and in very good health. His physician has prescribed atorvastatin, even though his cholesterol is under 200. He follows a Mediterranean diet with lots of vegetables. He bikes almost every day, but he is starting to complain that his leg muscles are becoming weaker. Does he really need to take a statin?

A: Doctors have been debating this question for decades. Most of the early clinical trials did not include people over 75. Studies of older people have produced unimpressive and contradictory results.

A recent study examined the health records of more than 46,000 people who were at least 75 years old. The authors found that individuals without diabetes who took statins for at least five years derived no discernible health benefit (BMJ, Sep. 5, 2018). The statin takers did not have less heart disease or live any longer than people who did not take statins. Older people may be more vulnerable to statin side effects, such as muscle weakness (Choosing Wisely, 2014).

We discuss this topic in much greater detail along with other medications that can be problematic for older people in our book “Top Screwups.” It is available at www.PeoplesPharmacy.com.

Q: I’ve had migraines, maybe a couple of them a year, for many years. When I first see the aura, I’ve found that taking an aspirin within minutes does the trick for me. It halts the migraine entirely. I don’t know if this would work for anyone else, but it’s been a lifesaver for me.

A: Medical guidelines suggest that aspirin or another NSAID is effective for mild to moderate migraine attacks (Acta Neurologica Taiwanica, June 15, 2017). Acetaminophen (Tylenol) in combination with an NSAID such as diclofenac, ibuprofen or naproxen also can stop an attack (Continuum, August 2015).

The makers of Excedrin Migraine have capitalized on the combination of acetaminophen, aspirin and caffeine. A randomized controlled trial demonstrated that this combination is better than placebo for treating migraines (Cephalalgia, November 2014). People who suffer migraines tell us that utilizing their treatment at the first hint of an aura increases the chance of success.

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