OBJECTIVE: Erectile dysfunction (ED) affects approximately 30 million men in the 
United States. The objectives of this study were to (1) assess the cost and 
utilization of sildenafil citrate (Viagra), an oral therapeutic agent for ED, in 
a large managed care organization (MCO) with a quantity limit of 6 units per 
30-day supply and (2) describe the incidence of comorbid conditions and the 
severity of cardiovascular disease in adult male users of sildenafil.
METHODS: Pharmacy claims for sildenafil were identified from an administrative 
database of claims with dates of service in calendar year 2001 for male members 
aged 18 years or older. Medical claims for MCO members who had sildenafil claims 
were used to identify comorbid diseases and categorize patients by degree of 
cardiovascular risk. High risk was defined as having at least 1 medical claim 
with a diagnosis of diabetes mellitus, ischemic heart disease, abdominal aortic 
aneurysm, or peripheral arterial disease, and medium risk was defined as not 
having any diagnosis in the high-risk category but at least 1 cardiovascular 
risk factor that included smoking, hypertension, hypercholesterolemia, family 
history of premature coronary heart disease, or being aged 45 years or older.
RESULTS: There were 67,914 pharmacy claims for sildenafil during 2001 for 20,281 
MCO members, an average of 3.3 pharmacy claims per patient. The prevalence of 
sildenafil use was 54.1 per 1,000 male MCO members aged 18 years or older. The 
total allowed charges for sildenafil pharmacy claims in 2001 were 3.56 million 
US dollars, of which patients paid 26.6% in average cost-share, and the net MCO 
cost per member per month (PMPM) was 0.18 US dollars. A total of 1,681 patients 
(8.3%) exceeded their quantity restrictions for sildenafil tablets in 2001, of 
which 1,362 (81.0%) paid cash and 319 (19.0%, or 1.6% of all sildenafil users) 
appealed and received approval from the MCO for additional sildenafil tablets 
beyond the restriction of 6 tablets per month. Medical claims were available for 
15,644 sildenafil patients (77.1%), and 12,720 sildenafil users (81.3% of those 
with medical claims) were judged to be at high or medium cardiovascular risk.
CONCLUSIONS: A quantity limit of 6 tablets of sildenafil per 30-day period was 
associated with a drug cost to users and the MCO of 0.25 US dollars PMPM. 
Sildenafil users paid an average cost-share of 26.6%, resulting in a net drug 
cost of 0.18 US dollars PMPM to the MCO.