Helping older couples maintain sex drive on a budget


TRENTON, N.J. — For many older couples, fun in the bedroom requires help from prescription drugs, but prices of popular brand-name sexual dysfunction drugs have tripled since 2010 and insurance coverage is spotty.

Doctors who specialize in treating impotence and women’s sexual problems say some patients say they’re forgoing sex because medicines are unaffordable.

Experts say couples needn’t choose between abstinence and breaking the bank. Here are some strategies:

Policy coverage: For women, health insurance usually covers new generic medicines and some brand-name ones for symptoms including vaginal dryness, which can make sex painful. For men, insurance may cover six Viagra or Cialis pills per month, which now cost $50 apiece without insurance or for additional pills above the limit. Be sure to check your copayment even if you have generous coverage.

If your plan doesn’t cover impotence pills, you may still be able to get some, but for a different reason. Viagra’s main rival, Cialis, is approved to treat an enlarged prostate, and insurers often cover Cialis for that condition. If you have urinary problems, your doctor might prescribe Cialis, says

Dr. Elizabeth Kavaler of New York’s Lenox Hill Hospital.

Generics: In mid-December, Viagra gets two generic competitors, which should reduce prices. But there’s a cheaper option now.

Dr. Nachum Katlowitz, head of urology at New York’s Staten Island University Hospital, offers patients with erectile dysfunction prescriptions for sildenafil. That’s the generic version of Revatio, the blood pressure pill Pfizer was testing when older male patients reported stronger erections as a side effect.

Pfizer went on to develop a higher-dose version and called it Viagra, but lower-dose Revatio is now available as generic sildenafil.

For women: With menopause, women’s levels of the hormone estrogen drop, reducing sex drive and causing vaginal dryness. Multiple prescription products containing estrogen restore moisture and reduce pain and other symptoms.

With insurance, popular ones such as Premarin pills and Estrace vaginal cream each cost about $60 per month. Without insurance, they can cost $150 or more per month. But several less-expensive estrogen patches and vaginal tablets sell for $10 to $80 per month without insurance.

Vagifem vaginal tablets recently got a slightly cheaper generic competitor called Yuvafem.

Stretching: Many pills come in different dosages, so some patients get the highest dose and split pills.

Some men take cheaper daily Cialis pills because only taking them on demand may be enough, or they get full-strength Cialis, which lasts 36 hours, for two nights of activity.