What’s your reaction to CVS/Caremark dropping coverage of Viagra?

“It’s certainly nice to have the option of the three different medications. I would have to say there’s already an increasing number of patients who are going to Canada to get their prescriptions because here, Viagra can cost $30-$40 for one pill. I can’t recommend that they go out of country, and they have concerns that it may not be the real thing, but I know people are taking it on themselves to do that anyway. 

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We certainly see this happening with a lot of other medications, where insurers negotiated a deal for the cheapest price. Cialis has kind of been the 800-pound gorilla, even though Viagra was first on the scene. So I’m not surprised that they cut some kind of a deal. Pharmacies out here are more interested in generics anyway. That’s where they make their money. So I don’t think it takes much to talk them out of doing away with one brand over another.

I don’t know which pharmacies carry generic sildenafil. I have put “generics permissible” on ED prescriptions and patients still end up with brands costing $40-$50 a pill.

I don’t think the CVS action will damage Viagra that much. They’ll find a way to get it to the market. It might even put some price pressure on Viagra, which could actually be a good thing. Viagra started out at $10 a pill, which we thought was ridiculous. Now it’s increased to $30-$50 a pill depending where you are. It’s absurd.

Cialis has been very good over the years in providing samples to doctors. That’s been good for them because patients definitely remember that. But they’re starting to get chintzy on their samples too. So I’m not against some price pressure on pharmaceuticals.”

David R. Flemming, MD
Monterey, CA

NEXT: "I think the choice of which medicine to use should be between the doctor and the patients, not the pharmacy or the insurance company."

Dr. Freedman“I think all the medicines we have available for ED are quite effective. But I think the choice of which medicine to use should be between the doctor and the patients, not the pharmacy or the insurance company.

This could hurt the insurer in the long run because some of the patients who have been on Viagra for the long term will perhaps go to other insurances.

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I’m told by patients it’s roughly $30 a pill around here. I remember when it was $10 per 100-mg pill back in 1998, and some patients were breaking it in half and taking 50 mg.

Patients do have an alternative now because they can buy generic sildenafil from some pharmacies in the United States. There’s a pharmacy we use that carries generic sildenafil for $2 a pill. Patients will take five of those for $10 instead of one Viagra. It’s not like sending them off to a foreign country where we’re not sure what they’re getting. So I don’t object, not if it’s saving someone $20 a dose.”

Sheldon Freedman, MD
Las Vegas

NEXT: "I just don’t understand why Viagra wants to raise prices, especially when insurances aren’t covering it and there are other competitive medications."

“Viagra is widely used and goes back to 1998. There were no alternatives then. Reps come to my office with samples and we tend to use whatever samples are available, because almost all of them work on the same principles now; they’re very similar.

Viagra has been around for a long time; its safety is well documented internationally. When patients go to the pharmacy now, we have to give the lower price alternative. Some patients get annoyed by that, but when they find out the alternative is cheaper, they will usually be happy we switched them. When patients find that Viagra costs $22 a pill, and that it’s not covered, they will often shop around at the discount pharmacies.

I just don’t understand why Viagra wants to raise prices, especially when insurances aren’t covering it and there are other competitive medications. They should lower the price, if they want to keep people using it. This may push the company to lower the cost.

A lot of patients have tried the sildenafil but have not been happy; they say it doesn’t work like Viagra. I don’t know if that’s in the mind or because the component is different.

I do think it could ultimately hurt CVS, because if people have an option, they may make the decision to change companies if they can’t get the medication they want.”

Yousef H. Salem, MD
Alexandria, VA

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