Just don’t do it.  If you have to ask why, then you’ve clearly not purchased Viagra, Cialis or any other ED pharmaceutical recently.   And you’ve not experienced the 300%+ increase in these drugs over just the past four years. The price for ED prescription drugs have shot through the roof because they are legal monopolies (thanks to patents) not subject to any price regulation.

When it first received FDA approval in 1998, 50mg pills were available for purchase at approximately $9 or $10 each. Since then, Pfizer has increased prices enormously. Where price rises occurred about once per year between 1998 and 2006, they have taken place about twice per year since. Price rises tended to be about 3-5% prior to 2006, and upwards of 7% since then, representing a total increase of more than 300% between 1998-2012.   In the last two years, the price has almost doubled further — a 500% increase since its first introduction!

In 2017, some — but not much — relief comes.   That’s because Pfizer, the maker of both Revatio and Viagra, maintains exclusive rights to Viagra’s patent through 2020—originally set to expire in 2012—after suing generic drugmaker Teva in 2010 for patent infringement. While the terms of the settlement are confidential, Teva will have to pay Pfizer a royalty for a license to produce the generic in 2017.    However, by 2020,  generic alternatives will be priced at 20 to 90% less than identical brand-name products. Since Cialis and Levitra are alternatives to Viagra, when their patents expire in 2018, we expect that their prices decrease swiftly and Pfizer may have to decrease the minimum price it requires for Viagra in the US market in order to retain market share. In light of the clear pattern in Australia, Canada and the UK,(see below) there is also expected to be a major fall in the price of Viagra in the US after Pfizer’s patent protection expires in 2020.

THE SILDENAFIL OPTION

You might want to ask your doctor about sildenafil—it’s the generic version of the drug Revatio, approved to treat pulmonary arterial hypertension. Sildenafil is also the same active ingredient that’s in the brand-name erectile dysfunction drug, Viagra. (Generic sildenafil as Revatio is available only in a 20-mg strength, while Viagra comes in 25-, 50-, and 100-mg doses).  For those who pay out-of-pocket (your insurance may not cover it unless you have pulmonary arterial hypertension), the generic version is way less expensive than Viagra—we found it for less than $1 per pill compared to almost $50 per pill for the branded version. Accordingly to Consumer Reports, if your doctor says it’s OK, you could save a lot.

WHY IS VIAGRA CHEAPER IN OTHER COUNTRIES?

It’s all about the patent and the monopoly.  In most other countries, Pfizer doesn’t enjoy these competitive advantages.   Most notably, the Canadian Supreme Court made a ruling in late 2012 that, for all intents and purposes, killed Pfizer’s patent for Viagra.  Pfizer played loose with the facts behind its Canadian patent and a generic drug maker challenged the company’s patent.  It took the better part of 6 years, but finally, the Canadian court system found Pfizer’s patent ended in 2014. A competitor producing a generic version of the same drug, Teva, entered the market, and Pfizer lowered its prices substantially. At present, Canadian pharmacies and stores sell Viagra at between US$1 and $7 per pill, averaging approximately 1/3 of the typical price in US stores and pharmacies.

The most important causes for vast price differences in Viagra in different countries include patent protection, the availability of generic drugs, competition from online vendors and GDP per capita.  In Australia, the price of Viagra fell a great deal after Pfizer’s patent protection expired in 2014, reflecting the cost of production and distribution more than the consumer’s ability to pay. The price of a pack of four pills fell from approximately US$180-250 to approximately $10.  In the United Kingdom, Viagra was sold at upwards of $10 per pill until Pfizer’s patent on the drug expired in late 2013. Prices were lower while the patent was in force in the United Kingdom than in Australian and Canada because of the bargaining power of the country’s National Health Service (NHS), which exerts a great deal of influence to drive drug prices down. Once the patent expired, approximately a dozen competitors entered the market and prices fell precipitously as a result. Unfortunately, there are some pharmacies in the UK that attempt to charge patients prices close to previous levels through unscrupulous prescribing practices. However, in most stores and pharmacies prices are currently around $1-$5 per pill.

In Egypt and India,  Viagra is sold over the counter — no prescription is required.  Thus, buying from an Egyptian or  Indian pharmacy working on the international market is also a good option.   India has its own regulatory agencies, and they’re more than adequate at making sure manufacturers make safe pills with appropriate ingredients — this isn’t like ordering toys from China. These are high-quality manufacturers producing high-quality products at a much lower price — not because they’re cutting corners, but because they’re not beholden to the same extortionate, market-distorting Pfizer tactics used in the U.S.   However, be careful.  If the source is not a reliable one, you can run into trouble.

FOREIGN DRUG STORES

Federal law prohibits people from buying their drugs from international online pharmacies, though millions of Americans do exactly that, because they offer far lower prices.   And these consumers are smart because you can buy safe drugs from international online pharmacies.   But you’ve got to know what you are doing. The first mistake most people make is relying upon an online search for “generic Viagra” and or “cheap Viagra”.  This will lead you to a plethora of websites (some claiming to operate out of Canada) selling deeply discounted pills without a prescription. But don’t be tempted—most of these online pharmacies are not legitimate.

Much like pharmacies in the United States, pharmacies in other countries are regulated by pharmaceutical laws with oversight and enforcement from regulators. These pharmacies must follow safety requirements for the handling and dispensing of medications, including the requirement to only dispense lawfully manufactured medications produced under “Good Manufacturing Practices” or GMP.   So consumers need to look for on-line drugstores that honor GMP.

Second, you’ve got to verify the safety of these online pharmacies.  One way to do this is to use PharmacyChecker.com, which is a free service that provides people with a trusted and free source for finding lower drug prices among verified online pharmacies.  In this way, you can avoid dangerous, rogue online pharmacies. By comparing medication prices on such sites, consumers can save a lot of money – often more than 80% — buying medications from international online pharmacies.

Finally, you’ll have some difficulty getting a prescription transferred to a foreign pharmacy.  If you plan on using a foreign pharmacy, we encourage you to get a written prescription from your doctor.   You’ll need to send a copy of this prescription in order to complete your order.   So don’t let your MD send the prescription directly to a pharmacy — get the written script yourself!

The Food and Drug Administration urges you avoid supplement versions as well. Hundreds of “herbal” or “all-natural” supplements that promise to enhance sexual performance contain undisclosed drug ingredients, combinations of undisclosed ingredients or excessively high doses, and even unknown contaminants. For example, one of the tainted products recently tested by the FDA included 31 times the prescription dose of tadalafil (the generic version of the drug Cialis), in combination with dapoxetine, an antidepressant that is not approved by FDA.