(163) The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company
Authors: Vercnocke J , Zhong A , Liaw A , Ginsburg K 
Published: February 2024

Abstract

Introduction
Direct-to-consumer (DTC) mail order pharmacies often entice patients with erectile dysfunction (ED) by highlighting the ability to obtain medication online and avoid an “awkward” doctor’s visit. The markup and cost of obtaining medications for ED through subscription services from DTC pharmacies that include a “telemedicine” visit remains unknown.

Objective
To compare the cost of generic ED medications available from DTC mail order pharmacies to Mark Cuban Cost Plus Drug Company.

Methods
We obtained the cost of medications from three direct-to-consumer online mail order pharmacies (hims, BlueChew, and Roman) as well as comparable medications which are available with a prescription from Mark Cuban Cost Plus Drug Pharmacy. Cost per pill, monthly costs, and annual costs were compared in a variety of subscription options from DTC pharmacies compared with Cost Plus Drug Company.

Results
Introductory packages of sildenafil started at $25/month at BlueChew (30mg, 6 pills/month, $4.17/pill), $26/month at hims (25mg, 4 pills/month, $6.50/pill), and $16/month at Roman (25mg, 4 pills/month, $6.25/pill). Alternatively, 30 pills at Cost Plus Drug Company costs $9.40 (20mg, 30 pills/month, $0.32/pill). Introductory packages of tadalafil started at $25/month at BlueChew (6mg, 4 pills/month, $6.25/pill), $30/month at hims (10mg, 4 pills/month, $7.50/pill)), and $39/month at Roman (5mg, 4 pills/month, $9.75/pill). Alternatively, 30 pills at Cost Plus Drug Company was $10.70 (10mg, 30 pills/month, $0.36/pill). The cheapest per pill price of sildenafil is $2.79 at BlueChew (30mg), $4.00 at hims (25mg), and $2.80 at Roman (25mg). To obtain the lowest price, patients are required to commit to 34 pills/month at $90 from BlueChew, a 12-month subscription for 16 pills/month totaling $768 from hims, and a 12-month subscription of 10 pills/month totaling $336 from Roman. The cheapest cost/pill at Cost Plus Drug Company was $0.15/pill (20mg) to obtain 90 pills for $13.40. These values are even more stark when ordering the highest strength and highest quantity of tadalafil for 1 year from each of DTC pharmacy: BlueChew $1,445 (9mg, 28/month, $4.30/pill), hims $1,284 (10mg, 16/month, $6.69/pill), and Roman $5,136 (20mg, 10/month, $42.80/pill)). 360 tabs of Tadalafil 20mg from Cost Plus Drug Company cost $75.20, $0.21/pill). This analysis is limited as the cost of a doctor’s visit to obtain a prescription is not included in the price of medications at Cost Plus Drug Company but is included in the direct-to-consumer services.

Conclusions
Direct-to-consumer online pharmacies that include a telehealth appointment and provide access to generic medications to treat ED have considerable markup. This markup likely exceeds the out-of-pocket cost for a primary care office visit needed to obtain a prescription to treat ED. Prescribers should inform patients of cost-effective methods to obtain commonly used medications to treat ED.

Disclosure
No.