Today’s lesson on health care economics:

On GoodRx, a month’s worth of sildenafil 20 mg costs $17.25

On the same site, a month’s worth of sildenafil 25 mg costs $507.24

Does anyone buy the 25 mg version? You bet – I saw a patient who was on it yesterday (don’t worry; he’s since been switched over).

What’s going on here? Sildenafil has two FDA approvals – one, under the name “Revatio”, for hypertension. The other, under the name “Viagra”, for – well, you know.

The FDA only approved Revatio at doses of 5 and 20 mg, and only approved Viagra at doses of 25 and 100 mg. So sildenafil 20 mg has “Revatio” on the box and sildenafil 25 mg has “Viagra” on the box. Revatio is generic and dirt-cheap; Viagra is still on-patent and expensive.

But can’t people who want Viagra just buy Revatio?

Yes, totally. But the average patient doesn’t know this is going on. And the average doctor doesn’t really have any incentive to care because they’re not the one buying it (I’ve had patients who have asked their doctor to prescribe the cheaper version, and the doctor has refused because they want to do it the “proper” way). And I think it’s illegal for the insurance companies to insist, because technically the FDA only approved sildenafil 25 mg for erectile dysfunction but didn’t approve sildenafil 20 mg.

(also, some people are like “But I need a higher 50 mg dose of Viagra, and Revatio only goes up to 20 mg!” As the ancient rationalist proverb goes, have you tried thinking about the problem for five minutes?)

At the advice of my doctor, I’m on pseudo-prescription naproxen. Instead of one 500mg prescription pill, I buy the 220mg OTC stuff and take double the dose on the label: it’s close enough, and it’s somewhat cheaper per mg if you don’t have prescription coverage. She said if I ever do get prescription coverage I should let her know and she’ll write me an official prescription then.

I love my doctor.

(Please do not take prescription-strength naproxen without medical supervision: you can fuck up your liver.)

Side benefit:

People in the spring: “it’s horrible that they’re making *chronically ill* people go to a *pharmacy* *every month* and risk plague! patients aren’t allowed to keep buffers of medications they often need to *survive*!”

Me: *looks with a mixture of relief and awkwardness at my 200-pack of Aleve*

(Note: I only need it around the onset of menstruation, so 200 OTC-sized pills is about a ten-month supply.)

(Store-brand naproxen doesn’t come in 200-pack, and the bulk-discount benefit outweighed the name-brand penalty.)


#other things my doctor has done: #prescribed prune juice for constipation #prescribed string for skin tags #used Big Pharma ”samples” to keep her poorer patients supplied with meds they would struggle to afford on their own #readily admitted that people in my situation don’t actually need gynecological checkups #and I should only see a gynecologist if something goes wrong or I decide to start having sex #reply via reblog #adventures in human capitalism #medical cw #illness mention #covid19 #menstruation #this probably deserves some other warning tag but I am not sure what

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