[Ip-health] AP (Dec. 2016): Can't buy love? Drug price hikes put sex beyond reach

Zack Struver zack.struver at keionline.org
Thu Feb 23 06:52:04 PST 2017


​Can't buy love? Drug price hikes put sex beyond reach
 Dec. 5, 2016 12:09 PM EST

​TRENTON, N.J. (AP) — Imagine not being able to afford one of life's great
pleasures — sex.

That's true for many older couples, doctors say. Soaring prices for
prescription medicines for impotence and other problems have put the
remedies out of reach for some.

Without insurance coverage, Viagra and Cialis cost about $50 a pill, triple
their 2010 list prices. The new "female Viagra," a daily pill for low sex
drive called Addyi, costs $800 per month. Older products for women also
have seen huge price run-ups, Truven Health Analytics data show.

"Many of them don't get past the pharmacy counter once they see the price,"
says Sheryl Kingsberg, a University Hospitals-Cleveland Medical Center
behavioral psychologist and researcher who counsels men and women.

What people actually pay out of pocket varies. Some insurance prescription
plans, including Medicare, cover some of the medicines. Some plans don't
cover any, arguing they're not medically necessary. Many require steep
copayments or limit the number of impotence pills per prescription.

"Once you get to a certain price point, sex becomes a financial decision,"
says Dr. Elizabeth Kavaler, a sexual dysfunction specialist at New York's
Lenox Hill Hospital. "It takes a lot of the joy out of this."

Five of six specialists interviewed by The Associated Press say patients
have told them they've given up sex because of the cost.

Now, a little relief is coming. Late next year, Viagra and Cialis will get
at least one generic competitor costing slightly less; prices will plunge
later when more generics reach the market. For women, an Addyi rival is in
late-stage testing. A few other products now have generic versions, and
other options are in development.

A generation ago, long-married couples accepted their sex lives trailing
off with age, Kavaler says. Key hormone levels drop with age, reducing sex
drive and causing problems such as impotence and vaginal dryness, which
often makes intercourse painful.

Today, midlife divorce is more common, divorced or widowed men and women
often seek new partners, and sex becomes important again. Meanwhile,
they're bombarded by ads for impotence remedies and other treatments.

"Couples in their 50s, 60s and 70s are more sexual than they've ever been,"
says Kavaler.

Until Pfizer launched the first impotence pill, Viagra, in 1998, there were
few options for men besides penile implants and injections. Viagra and
Cialis each quickly topped $1 billion in global annual sales, and products
for women's symptoms eventually followed. However, price hikes appear to be
limiting usage for some products in the U.S., where prices aren't regulated.

Since 2010, the number of Viagra prescriptions filled in the U.S. has
fallen 42 percent to about 5 million a year. Meanwhile, prescriptions for
Cialis, which now has a popular daily pill option, have gone up slightly,
according to health data firm QuintilesIMS.

Popular women's estrogen products such as Vagifem vaginal tablets and
Estrace cream also have seen prescriptions decline in recent years. Addyi,
only on the market for a year, has had dismal sales.

Dr. Lauren Streicher offers women four treatment options, and most pick
Vagifem. A month's supply costs $170 and insurance coverage is limited. A
generic version, Yuvafem, just launched at a slightly cheaper price.

"They go to their pharmacy and see how much it costs, and then they call me
up and say, 'I can't do it,'" says Streicher, director of the Center for
Sexual Medicine and Menopause at Northwestern University's medical school
in Chicago.

But not being able to have sex "is a deal-breaker in a lot of
relationships," she adds.

The drugs' makers insist list prices far exceed the negotiated prices
insurers pay them and say they price products based on their value.
According to the companies, nearly all their customers are insured. Pfizer
says most insured Viagra users pay $6 to $8 per pill, for instance.

Patients unwilling to forego sex, doctors say, split pills or otherwise
ration medicines, beg for scarce samples or seek copay discount coupons.
Men with enlarged prostates can request Cialis because it's also approved
for that condition, usually with insurance coverage. Some women make do
with over-the-counter lubricants.

Many shop for price, which can vary widely by pharmacy.

Others take a big risk, buying "herbal Viagra" at gas stations or ordering
Viagra online from "Canadian pharmacies" that likely sell counterfeit drugs
made in poor countries, says Dr. Irwin Goldstein, director of San Diego
Sexual Medicine.

Some doctors have gotten inventive.

Dr. Nachum Katlowitz, head of urology at New York's Staten Island
University Hospital, offers an alternative costing about $1 per pill at
some pharmacies. The active ingredient in Viagra —sildenafil — is also in
Pfizer's now-generic blood pressure pill Revatio but at one-fifth the dose.

One of his patients, a 62-year-old hospital technician, takes several of
the blood pressure pills before sex.

"I couldn't afford it if I had to pay for Viagra," says Robert, who asked
that his last name not be used to protect his privacy.

He's experienced modest improvements and says he and his wife of 28 years
now enjoy sex twice as often.​

Zack Struver, Communications and Research Associate
Knowledge Ecology International
zack.struver at keionline.org
Twitter: @zstruver <https://twitter.com/zstruver>
Office: +1 (202) 332-2670 Cell: +1 (914) 582-1428

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