New generic Viagra is here, cutting pharmacy bills for Michigan men in search of erections

America's favorite little blue pill has gotten a fairly big price tag over the past 19 years.

Now the costs of drugs like Viagra for treating male erectile dysfunction are finally coming down.

Pfizer, the maker of Viagra, on Monday introduced the first official generic version of its blockbuster impotence pill. 

The drug costs $30 to $35 per pill, about half the price of brand-name Viagra. Generic maker Teva Pharmaceuticals can also introduce its own Viagra generic beginning this week, although the company hasn't announced whether it will.

Some of the lowest consumer prices for generic Viagra are already offered by specialized pharmacies as well as new e-commerce startups, such as New York-based Roman Health, which has an online prescription service and mail-order pharmacy that delivers doses of Viagra's active ingredient — sildenafil citrate — for $4 to $10.

There is currently no mainstream generic version of Cialis, a popular and longer-lasting erectile dysfunction drug, but one could hit the market as early as September 2018.

For men with E.D., the arrival of more generics could make it easier and cheaper for them to treat their condition, said Dr. Ali A. Dabaja, a urologist with the Henry Ford Health System.

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Many health insurance plans limit the number of E.D. pills they will cover, and some don't cover brand name E.D. drugs at all. That means patients often pay the full price of the pills.

"We've noticed patients struggling to pay for the medication," Dabaja said. “I think it’s kind of unfair that a lot of insurance companies, especially in the state of Michigan, have limited coverage for sexual health. Erectile dysfunction is a disease, so it is unfortunate.”

A representative for Blue Cross Blue Shield of Michigan, the state's largest health insurer, said its E.D. drug coverage varies based on particular health plans and can range from six to 12 pills per month to a requirement that patients first try any available generics.

Priority Health said that employer groups can chose an optional drug rider that will cover E.D. drugs. 

"We would treat any new generic like we normally do, which means generics typically are less out of pocket for a member than brand-name drugs," said Blue Cross spokeswoman Helen Stojic.

Viagra revolutionized the treatment of erectile dysfunction in 1998 as the first oral pill for improving penis erections. As many as 40% of men 40 and older have some E.D. issue, according to one health study, with prevalence increasing with age.

More than 13 million U.S. prescriptions were issued in 2016 for brand-name E.D. drugs, generating $3.5 billion in sales, according to health industry data firm IQVIA. Viagra was the second most prescribed pill last year behind Cialis, which became No. 1. in 2014.

Pfizer initially sold Viagra at a wholesale price of $7 per pill, or around $8.50 to $9 a pill for consumers after pharmacy markups, according to press reports at the time. The pharmaceutical giant steadily raised Viagra's price over the years, even as similar medications such as Cialis, Levitra and Stendra came out.

As prices rose, flashy websites sprang up promising cheap "generic Viagra" through the mail. But many of those pills were counterfeits, sometimes from overseas, and could contain diluted doses of the drug or even non-medication.

"Eighty percent of all Viagra purchased online is counterfeit," said Zachariah Reitano, 26, co-founder of Roman Health, which says it sources all of its generic sildenafil (Viagra's active ingredient) from accredited U.S.-based wholesalers. "The medication can often contain printer ink, paint that they might use to try and get the blue hue, or even floor wax." 

A legitimate generic sildenafil that has been available for several years and is sometimes used by men with E.D. is a smaller, white pill that comes in 20 milligram doses and can be priced as low as $1. This is a generic form of another Pfizer drug, Revatio, meant for treating high blood pressure in the lungs, a condition known as pulmonary arterial hypertension.

The sildenafil in both drugs is essentially the same. Some patients will swallow several of these generic pills to equal the effect of brand name Viagra, which is generally prescribed in 50 mg and 100 mg doses.

"They basically do the same thing," said Dr. Frank Burks, a urologist at Beaumont Health. "They stimulate nitric oxide in the tissues of the penis to help promote an erection."

Burks said that before generic sildenafil was readily available in the U.S., some of his patients would get their prescriptions for it filled at Canadian pharmacies, either by driving to Windsor or by mail order.

Generic sildenafil has been readily available for several years in foreign markets, including the United Kingdom, where brand name Viagra could reportedly be sold over-the-counter next spring.

It is illegal to import drugs into the U.S. from Canada, but authorities typically do not prosecute individuals who bring back a small amount of prescription drugs for personal use.

There are now pharmacies in metro Detroit that sell generic sildenafil for well below the cost of brand name Viagra. And some compounding pharmacies have started offering generic tadalafil, the active ingredient in Cialis, he said.

"Most of the patients that purchase generic sildenafil pay out of pocket," Burks said. "But it's $1 a pill, so it's affordable."

Yet despite years of Viagra and Cialis advertisements aimed at normalizing anti-impotence drugs, some men with the condition are still too embarrassed to go to a doctor's office and get treatment.

Roman Health is trying to reach those men with its online prescriptions and mail-order pharmacy, which ships single-dose packets of E.D. pills in discrete brown boxes. Reitano, the startup's 26-year-old cofounder, said he suffered from E.D. as a result of a heart condition.

"There's definitely embarrassment and stigma falsely attached to the issue," he said. "It's just blood flow, and so it really shouldn't be as closely linked to someone's ability to feel like a 'real man.'"

Roman expanded to Michigan last month and contracts with Michigan doctors to conduct customers' "online visits," verify their identity via photos and government IDs, and answer questions by chat, phone or Skype. The online consultation costs $15 and is refundable if a customer isn't a good candidate.

Reitano said his doctors are on the lookout for people who may try to get erection pills to counteract the effects of hard partying and don't truly need them.

"They will not prescribe medication for someone who uses dangerous drugs or who doesn't have a problem getting and maintaining an erection," he said.

Although Pfizer's patent on Viagra does not expire until 2020, it reached a court settlement four years ago with generic maker Teva that allowed Teva to start offering a generic sildenafil for E.D. this month. Other generic makers can eventually enter the market with their own sildenafil, likely driving pill prices down further.

Pfizer also plans to start a new discount home-delivery program in January, Pfizer Direct, that will sell brand name Viagra for 50% off the current $61.54 wholesale price for 50 mg or 100 mg tablets.

But E.D. pills don't work for every patient.

The Boston Medical Group in Southfield is one of several clinics in southeast Michigan that specialize in treating men who haven't responded to the pills.

One of the clinic's treatments involve injecting erection drugs directly into the penis, producing an unsuppressable erection for up to two hours. E.D. pills — when they do work — aren't supposed to cause erections unless the patient is aroused.

Dr. William Livingston, a Boston Medical urologist, said the penis injections use a small gauge needle and are "totally painless."

"It doesn't hurt at all," Livingston said. "I know; I use it myself."

The injections are successful on 98% of patients who come through, he said.

"Sometimes in a guy who hasn't had an erection for two or three years, I put him in a waiting room to let that develop, and in 15 to 20 minutes I go into the room and he's laughing," Livingston said. 

The New York Times reported last week that embattled movie producer Harvey Weinstein allegedly had female assistants procure such penis injection drugs before his sexual encounters, sometimes delivering them in brown paper bags.

Contact JC Reindl: 313-222-6631 or jcreindl@freepress.com. Follow him on Twitter @JCReindl.