ED medications 101

By Ginger Manley | Posted: Tuesday October 1, 2013

September 2013

Dear Ginger
My Medicare Part D insurance plan does not cover the cost of ED medicine. I saw an advertisement for getting a 30 tablet free sample of Cialis™ and I wonder if this is a good thing to do?
James


Hi James
Your question touches on a number of issues around this topic. I will address each one and then tie them together.
Over 15 million men in the United States have some concerns about the quality or quantity of their erections--erectile dysfunction or ED. Most of these men are over the age of sixty and most of the changes are attributable to normal changes of aging. Erections require good enough blood supply to the genital organs, good enough nerve conduction down and up the spine and beyond, good enough hormone production, especially the hormone testosterone, and good enough mental wellness for a man to be able to get and keep an erection.
Notice I said "good enough"--not perfect. Most of these physical functions change over time--arteries become thickened and hardened preventing blood to flow as it once did; nerve endings lose their ability to receive sensations as sharply or to signal muscles to respond as robustly as when one was younger; testosterone production declines a little with each decade; periods of grief or depression sometimes characterize older life. In many men, these biological processes remain good enough to support a vigorous sex life into the sixties or seventies, but more men than not experience some problems with erections later in life. In the almost twenty years since prescription drugs to treat this problem came onto the market, millions of men have benefitted by using these ED medications.
There are presently three ED medications available by prescription--sildenafil (Viagra™), vardenafil (Levitra™), and tadalafil (Cialis™). All three work in very similar ways by increasing blood flow to the penis and they differ around onset and duration of effect. Additionally, all three are well tolerated by most men and provide satisfactory-enough erections to promote sexual well-being ways not known to earlier generations of aging men.
However, here is the rub. Each tablet of any of the ED medications costs between $10-$15 when purchased from a local pharmacy and for many men who need them, this is an out of pocket expense. These medications fall into the same category as do cosmetic drugs--they are approved by the US Food and Drug Administration (FDA) for treatment of a medical disorder--but they are not deemed by many insurance plans as medically necessary. While some drug companies, like Pfizer, the maker of Viagra™, say that a majority of consumers have prescription coverage for their product, the reality is that most commercial insurance carriers do not include this category in their coverage. For men over the age of 65, there are no Medicare Part D plans that cover erectile medications as far as I know. Interestingly, TriCare for Life, the government program for military retirees who are receiving Medicare Part A, does cover these drugs, using a formulary approach.
Most health care providers prescribe a set amount of ED medication as a monthly supply--usually six to ten tablets, costing a man somewhere between $60 and $150 out of pocket, depending on where he gets his prescription filled and how often he uses the medication. For a man who has a fixed or limited income, that can be a significant piece of change, especially if he does not "get lucky" after taking the pill. In those cases, all he may have to show for his $10 is a glowing red face, the most common nuisance side effect of these drugs.

A few changes are occurring. Many men who have ED also have problems with enlarged prostates and sometimes the enlarged prostate may be a contributor to the ED. In medical lingo, an enlarged prostate not related to cancer is called Benign Prostatic Hyperplasia (BPH). BPH causes significant urinary symptoms, including urinary urgency and frequency (especially frequent nighttime urination), urinary hesitancy, straining to urinate, and incomplete bladder emptying, and dribbling after urination. Taken together these urinary symptoms are called Lower Urinary Tract Symptoms or LUTS. Over the past few years, studies have shown that when  ED medications are combined with other more common drugs for BPH, the ED drugs produce a more beneficial result than when the traditional BPH drugs are given alone. The FDA has now approved one ED drug, tadalafil (brand name Cialis™), to be taken on a daily basis for treatment of LUTS at a lower dose than would be used just for treatment of ED.
Every drug company lives for an endorsement from the FDA and the  Eli Lilly Company, maker of Cialis™, wasted little time beginning to capitalize on the recommendation. The advertisements you are seeing, James, especially the full-page ads for Cialis™, running in most major newspapers and on the Internet, are touting the benefits of Lilly's favorite ED drug. A man whose health care provider prescribes Cialis™ for him for treatment of BPH and ED or for ED alone  can take the prescription to his pharmacist along with the voucher from the ad and he will receive either 30 tablets of the lower dose for daily use of Cialis (2.5-5.0 mg) or three regular dose tablets (10-20 mg). It does not take a rocket scientist to figure which of these free offers most men would prefer. Pfizer Company has a similar free offer on the Internet for three free Viagra™ tablets when a man has a prescription for the drug.
In addition, any of us who have Internet mail accounts have regularly received offers for free ED medications from "Canadian pharmacies" or elsewhere. Some health food stores offer non-FDA approved supplements touted as helpful for ED. All of these ventures hope to capture naive men who want help for ED but who either cannot or will not get and fill a prescription given to him from their health care provider. Buyers beware--these are often scams at best and very unsafe at worst.
So, James, there you have it. If you have a prescription for the medication, by all means use it for this free trial. You will have saved a bundle of money, which you can then use to take your intended lady out to dinner as part of a romantic evening. Remember, though, avoid a meal high in fat or having more than one glass of wine if you want to have the best response from your new medicine in the bedroom. Happy Homework!

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