Generic Revatio

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
ZakMeister

ZakMeister

RPh
10+ Year Member
Joined
Dec 12, 2012
Messages
245
Reaction score
27
Sildenafil 20mg is going to hit the market soon, or may be it is already. Just thinking how it's going to go around in the market. Usually, viagara 50mg are used once or twice daily max for ED. Is it possible that MDs try to use the sildenafil 20 which is appropriate for PH (q4-6h) for viagara? Do insurances audit the scripts or the insurance will right away reject the script as DUR?
Members don't see this ad.
 
Sildenafil 20mg has been out for probably three years now, and I'm yet to see a prescription for it outside of legit PH use. The chains still mark it up stupid high, so there's no desire for it at cash price, and any self-respecting PBM would put a PA on it.
 
  • Like
Reactions: 2 users
CynicalIntern said:
Sildenafil 20mg has been out for probably three years now, and I'm yet to see a prescription for it outside of legit PH use. The chains still mark it up stupid high, so there's no desire for it at cash price, and any self-respecting PBM would put a PA on it.
Click to expand...
If the PBMs didn't put a PA on it let's say,
Can they issue a DUR reject on it if the sig isnt for PH?
 
Members don't see this ad :)
One PBM locally requires generic sildenafil for all Viagra patients. They cover 30 tablets per month and doctors usually write for the patient to take the equivalent dose (e.g. 1, 3, or 5 tablets as needed)
 
ZakMeister said:
If the PBMs didn't put a PA on it let's say,
Can they issue a DUR reject on it if the sig isnt for PH?
Click to expand...
I mean, conceivably sure. But an overrideable DUR rejection is only going to stop a pharmacist maybe 1 out of 50 times. If you can make it go through, you're going to make it go through. Especially since the reimbursement on it is so low, if they want to come at you with a chargeback, you're only going to lose like 3 bucks.
 
Generic Sildenafil 20mg has been out. If you try to bill for it, it's an automatic PA.

We've already been selling Sildenafil 20 mg to our patients at the independent where I work if their Viagra script is not covered/coupon not available. Most of our patients all go to the same doctor so we've already spoken to him about it.

Our acquisition cost for a bottle of #90 Sildenafil 20 mg is $40. We sell it to the patients for cash for $100. It's actually an idea I came up with, patients love it and owner is cool since he's getting $60 profit/script.
 
  • Like
Reactions: 1 users
Sparda29 said:
Generic Sildenafil 20mg has been out. If you try to bill for it, it's an automatic PA.

We've already been selling Sildenafil 20 mg to our patients at the independent where I work if their Viagra script is not covered/coupon not available. Most of our patients all go to the same doctor so we've already spoken to him about it.

Our acquisition cost for a bottle of #90 Sildenafil 20 mg is $40. We sell it to the patients for cash for $100. It's actually an idea I came up with, patients love it and owner is cool since he's getting $60 profit/script.
Click to expand...
How much profit do you make when the insurance covers though? The generic is new so must be a great deal I reckon
 
Sparda29 said:
Generic Sildenafil 20mg has been out. If you try to bill for it, it's an automatic PA.

We've already been selling Sildenafil 20 mg to our patients at the independent where I work if their Viagra script is not covered/coupon not available. Most of our patients all go to the same doctor so we've already spoken to him about it.

Our acquisition cost for a bottle of #90 Sildenafil 20 mg is $40. We sell it to the patients for cash for $100. It's actually an idea I came up with, patients love it and owner is cool since he's getting $60 profit/script.
Click to expand...

You guys are getting hosed. I can get a bottle of 90 for $12.
 
ZakMeister said:
How much profit do you make when the insurance covers though? The generic is new so must be a great deal I reckon
Click to expand...
The generic isn't new. It came out while I was still in school. So when the insurance covers it (which very few people probably see, as a ton of PBMs have it set as "must fill through specialty), you're looking at maybe cost plus fifteen dollars? Not like generic Abilify, where I've made 2500 dollars off three scripts this week. Generic Abilify is my current best friend

And yeah, my acquisition cost for 90 is a little over 10 dollars.
 
Members don't see this ad :)
CynicalIntern said:
The generic isn't new. It came out while I was still in school. So when the insurance covers it (which very few people probably see, as a ton of PBMs have it set as "must fill through specialty), you're looking at maybe cost plus fifteen dollars? Not like generic Abilify, where I've made 2500 dollars off three scripts this week. Generic Abilify is my current best friend

And yeah, my acquisition cost for 90 is a little over 10 dollars.
Click to expand...

Yup,, one of the pharmacists at the hospital where I work told me he opened next to a psychiatric clinic. He only fills like 100 scripts/day but most of them are very good reimbursement. No technicians. If he's not working his brother who's a pharmacist covers the store.
 
Cash price is still high, but if you use the ever controversial discount cards, they are extremely affordable. Like $1/pill. Beats the hell out of $30-40ish for brand name, even if it is a tad lower strength.
 
I may be wrong here but I was wondering whether you can substitute the generic sildenafil 20 mg for a script clearly written for Viagra since the generic is orange-book-coded for Revatio? How do you go around the technical?
 
PharmdA07 said:
I may be wrong here but I was wondering whether you can substitute the generic sildenafil 20 mg for a script clearly written for Viagra since the generic is orange-book-coded for Revatio? How do you go around the technical?
Click to expand...
You cannot
 
  • Like
Reactions: 1 user
zelman said:
You cannot
Click to expand...


So what's with all the previous talk about dispensing generic 20 mg? Because Viagra itself is not available in 20 mg... I am confused! Are they talking about dispensing generic for Revatio Rx? or for Viagra Rx?... sorry it's been a long day ....
 
Last edited:
PharmdA07 said:
So what's with all the previous talk about dispensing generic 20 mg? Because Viagra itself is not available in 20 mg... I am confused! Are they talking about dispensing generic for Revatio Rx? or for Viagra Rx?... sorry it's been a long day ....
Click to expand...
If a script is written for Viagara, u can't automatically substitute it to the generic that's out. But if u have a collaboration with doc, they can prescribe a higher dose of sildenafil (ex-40mg). But then again chances are they will have to go thru PA and they may reject it
 
PharmdA07 said:
So what's with all the previous talk about dispensing generic 20 mg? Because Viagra itself is not available in 20 mg... I am confused! Are they talking about dispensing generic for Revatio Rx? or for Viagra Rx?... sorry it's been a long day ....
Click to expand...

ZakMeister said:
If a script is written for Viagara, u can't automatically substitute it to the generic that's out. But if u have a collaboration with doc, they can prescribe a higher dose of sildenafil (ex-40mg). But then again chances are they will have to go thru PA and they may reject it
Click to expand...

Scenario. Patient comes from doctor, script for Viagra 50 mg #6 1 tab 1 hour prior to intercourse PRN.

I already have spoken to the doctor that these patients will not pay for the brand name Viagra but they'll pay for the generic revatio. I've already been authorized to automatically switch those scripts to Sildenafil 20 mg #90 3 tabs 1 hour prior to intercourse PRN. (when Viagra not covered).
 
Sparda29 said:
Scenario. Patient comes from doctor, script for Viagra 50 mg #6 1 tab 1 hour prior to intercourse PRN.

I already have spoken to the doctor that these patients will not pay for the brand name Viagra but they'll pay for the generic revatio. I've already been authorized to automatically switch those scripts to Sildenafil 20 mg #90 3 tabs 1 hour prior to intercourse PRN. (when Viagra not covered).
Click to expand...
But they are not therapeutically equivalwnt (viagara to sildenafil) so I suppose cash is the only way then. It will be surprising to see PBMs cover it, thought it seems cash is the only way out for now
 
it's not a substitution, he writes an entirely new script
 
  • Like
Reactions: 1 users
Vain Brother said:
it's not a substitution, he writes an entirely new script
Click to expand...
ZakMeister said:
But they are not therapeutically equivalwnt (viagara to sildenafil) so I suppose cash is the only way then. It will be surprising to see PBMs cover it, thought it seems cash is the only way out for now
Click to expand...

So basically MD intentionally writes out "generic sildenafil 20 mg" for an indication of ED--which is meant to be for Viagra? Is there any data confirming that revatio generic will work equivalently to viagra brand in term of ED treatment? I can't seem to find any. I staff at a very affluent location and people have been asking me about using Revatio generic for the purpose of ED (something meant to be treated with viagra --brand of course since there's no generic for it) and I've been telling them that the FDA has not approved the generic for use other than the official PAH. Any insight is appreciated....
 
it's the same medication, so of course it would work the same...

as far as @Sparda29's interchange goes, my understanding is that the MD writes for viagra, it gets rejected, and then the pharmacist just writes an entirely new verbal order for sildenafil

we go to school for >6 years for this, guys. a little imagination and problem-solving skills shouldn't be all that much to ask
 
  • Like
Reactions: 1 user
Vain Brother said:
it's the same medication, so of course it would work the same...

as far as @Sparda29's interchange goes, my understanding is that the MD writes for viagra, it gets rejected, and then the pharmacist just writes an entirely new verbal order for sildenafil

we go to school for >6 years for this, guys. a little imagination and problem-solving skills shouldn't be all that much to ask
Click to expand...

I understand the scenario; however, I think it can only be done at independent. For a big-box chain or grocery chain, I don't think I would be comfortable spending time calling and doing all the details. In my case at my primary location as an outpatient, I don't think I'll be doing this...
 
but you don't call every time. you agree to a protocol with the MD in advance
 
Vain Brother said:
but you don't call every time. you agree to a protocol with the MD in advance
Click to expand...

Yeah that's why I said it's feasible at indie's...I've seen it done there with cough syrup for kids, steroid creams, etc. But for major corps where you're bound by billions of technical state/federal laws and rules, I'd think twice just to CYA.
 
i guess you'd have to go through your PIC/DM or something for the OK, but as far as i know indies and chains are governed by the same laws
 
PharmdA07 said:
So basically MD intentionally writes out "generic sildenafil 20 mg" for an indication of ED--which is meant to be for Viagra? Is there any data confirming that revatio generic will work equivalently to viagra brand in term of ED treatment? I can't seem to find any. I staff at a very affluent location and people have been asking me about using Revatio generic for the purpose of ED (something meant to be treated with viagra --brand of course since there's no generic for it) and I've been telling them that the FDA has not approved the generic for use other than the official PAH. Any insight is appreciated....
Click to expand...
The human body is an incredible thing. Your body can sense the tablet's dimensions, color, and imprint. If it is not a blue diamond, none of the sildenafil will affect penile bloodflow. If it isn't brand name Viagra, it simply cannot work. This is the same mechanism that allows patients to be allergic to generics, and only respond to Greenstone brand alprazolam.
 
Last edited:
  • Like
Reactions: 5 users
PharmdA07 said:
I understand the scenario; however, I think it can only be done at independent. For a big-box chain or grocery chain, I don't think I would be comfortable spending time calling and doing all the details. In my case at my primary location as an outpatient, I don't think I'll be doing this...
Click to expand...

Just document the original script for Viagra. "spoke to MD_X, change to sildenafil 20 mg #90, 3t po 1 hr before intercourse x refills". That's not that hard to do. You're not billing this through insurance as it will generate a prior authorization and a prior authorization will not be approved for erectile dysfunction. This is simply to provide a cheaper cash option.

Now at the big box chains and grocery chains, I don't think a pharmacist has control over prices. If you cash something out over there, the system generates some automatic cash price for you and you cannot alter the price.

At the independents with our software system, when you cash something out, it does generate a price but you can edit it. For sildenafil 20mg #90, our system generates a price of $2000 (AWP is $1800-ish), but I just adjust it to $100.
 
Last edited:
Sparda29 said:
Now at the big box chains and grocery chains, I don't think a pharmacist has control over prices. If you cash something out over there, the system generates some automatic cash price for you and you cannot alter the price.
Click to expand...

Strictly speaking, I can edit the price. In reality I almost never do it.
 
Cash price for #30 sildenafil 20mg is around $25 at Costco.
 
When I try to edit the price in rxconnect it refuses saying the price was too low and to contact the help desk.
I suppose at the register it would be easier.
 
PharmdA07 said:
Is there any data confirming that revatio generic will work equivalently to viagra brand in term of ED treatment?
Click to expand...

Drugs can legally be prescribed off-label, there doesn't have to be any data to confirm the equivalency. Of course, no one is going to waste money bothering to confirm the equivalency since sildefenil is going to work like sildefenil, theoretically there could be slight bioequivalency issues, but since the doses aren't the same anyway, it doesn't matter (ie if 20mg doesn't work, then the dr can titrate up to a dose that does work.)
 
You must log in or register to reply here.
Next unread thread

Similar threads

S
"Billionaire Mark Cuban Launches Online Pharmacy With Generic Drugs at Affordable Prices."
Replies
12
Views
2K
Splenda88
S
S
Manufacturing Locations of Generic Drugs in EU
Replies
2
Views
502
deleted820760
D
S
Generic Pregabalin
Replies
2
Views
844
ValeRx
ValeRx
genesis09
Generic Advair
Replies
4
Views
867
WVUPharm2007
WVUPharm2007
WVUPharm2007
Generic Suboxone Film came in today...
Replies
2
Views
1K
PharmDBro2017
PharmDBro2017
Top