(254) THE PRICE OF ED: ANNUAL OUT OF POCKET COST DISPARITIES OF ERECTILE DYSFUNCTION MEDICATIONS
Authors: Gurayah A , Kuchakulla M , Thorogood S , Fisch R , Davuluri M 
Published: December 2024

Abstract

Introduction
The prevalence of erectile dysfunction (ED) in the United States is estimated to be as high as 52% with older men more likely to experience ED. The initial treatment involves the use of phosphodiesterase 5 inhibitors (PDE5-I) to help sustain erections. However, there is wide variability of insurance coverage for PDE5-I, often making the medication inaccessible due to cost barriers. Thus, many discount programs have been created to provide more affordable options. Our goal was to understand the variability in cost through traditional Medicare Part D drug coverage programs and other popular discount programs.

Objective
To compare the costs of common ED medications between online discount platforms and Medicare Plan D.

Methods
We collected data on annual out-of-pocket (OOP) costs for ED medications from four different sources: Medicare Plan D, GoodRx, Mark Cuban Cost Plus Drug Company (MCCPDC), and Amazon Pharmacy. We compared the cost of lowest and highest routinely prescribed dosage of medications based on 30 tablets-per-month usage for three medications (Sildenafil 20 mg/100 mg, Tadalafil 2.5 mg/20 mg, Vardenafil 10 mg/20 mg). We compared the cost of PDE5-I under Medicare part D at 1) hospital retail pharmacies (identified using twelve different zip codes encompassing areas with comprehensive urologic oncology centers) and 2) commercial retail pharmacies (CVS, Walgreens, and Walmart – known to be large commercially available pharmacies in the United States). We compared these to GoodRx (at CVS, Walgreens, and Walmart), MCCPDC, and Amazon Pharmacy using R (V4.1.1).

Results
For Sildenafil 20 mg, the Plan D groups were comparable ranging from $1024-$1098 (Table 1). The cost of online platforms was cheaper, ranging from $82-$275. For Sildenafil 100 mg, the hospital-based pharmacies had a median price of $1446, whereas retail pharmacies under Plan D ranged from $22528-$22542. Online platforms for this drug were preferred at a cost of $89-$324. For Tadalafil 2.5 mg, the Plan D groups ranged from $4721-$4759. The cost of this drug via online platform was much lower, ranging from $82-$312. For Tadalafil 20 mg, the cost via Plan D ranged from $25210-$25235. The online platforms were reported to have much lower costs ranging from $103-$496. Vardenafil (both 10 and 20 mg) ranged from $19015-$19039 from Plan D groups and $86-418 from online pharmacies. For both sildenafil dosages and tadalafil dosages, Costplus was the most affordable option. For Vardenafil, GoodRx CVS was the cheapest option. We then compared the Plan D groups, GoodRx pharmacies, Costplus and Amazon and found that the costs of drugs via the discounted pharmacies were much cheaper compared to Plan D Medicare (Fig. 1).

Conclusions
Our results demonstrate that online discount pharmacies and GoodRx offer significant cost-savings for patients when compared to Medicare Part D plans. The high price variability at pharmacies due to minimal coverage of these drugs with Plan D may confuse and complicate drug purchases for patients. This analysis highlights the considerable cost disparity between traditional retail drugstores and discount platforms like GoodRx, MCCPDC, and Amazon Pharmacy. When counseling patients, healthcare providers can educate patients on these alternative platforms to increase access to essential medication and alleviate financial burdens.

Disclosure
No.