How to Save Money on Sildenafil Prescriptions in Ireland

A secondary analysis of

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Sildenafil was legally reclassified to a ‘pharmacy’ medicine in the UK in 2018. Aim To assess the prescribing patterns and costs associated with prescribing of ED drugs in England, and to investigate the link between prescribing and deprivation, regional demography, and legal reclassification. Design & setting Analyses were conducted of publicly available government data from various sources pertaining to primary care prescribing and demographics in England. Method Prescribing and cost data from January 2009 to November 2019 were extracted and adjusted for inflation, male populations, and regional deprivation. Results Between 2009 and 2019 the rate of prescribing, measured as the number of items per 1000 men, increased by 110%.

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In 2019, the rate of prescribing of ED medicines in the most deprived areas was 21.0% higher than the rate observed in least deprived areas. The northern regions of England approximately had a 50% higher rate of prescribing compared with London. A 1.3% annual increase in the number of prescription items was observed between 2018 and 2019 for Sildenafil, with a 5.8% increase observed from 2017–2018. Conclusion The two-fold increase in the rate of primary care prescriptions in the past 10 years suggests that more men are being screened for, or seeking help for, ED. The higher rate of prescribing offers opportunity for monitoring of linked risk factors, such as diabetes mellitus, dyslipidaemia, and vascular disorders, in deprived populations.

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Reclassification of sildenafil had a modest impact on prescribing practices. There is a dearth of research in relation to presentation and management of ED in primary care, particularly in the UK. This study shows that over the past 10 years, there has been more than a two-fold increase in the rate of primary care prescriptions for ED, accounting for the changes in population. The reclassification of sildenafil as a pharmacy medicine in 2018 seemed to have modest impact on the prescribing trend. It is very likely that more men are being assessed for ED or seeking help in primary care in England. routinely collected data on

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In addition, data suggest that prescribing sildenafil cenforce is linked with deprivation. There is an opportunity in primary care for assessment of linked risk factors in men who present with symptoms. ED, ‘the persistent inability to achieve or maintain an erection that is sufficient to permit satisfactory sexual performance’, can affect the physical, emotional, and psychosocial health of the sufferer.1 ED can have both an organic and psychogenic origin, and can be a risk marker for underlying cardiovascular diseases (CVDs) and mental health conditions, which may warrant further evaluation and treatment.2,3 Medications, such as antihypertensives, antidepressants, and antipsychotics, can also lead to ED through their mechanisms of action.2 A systematic review reported that men with ED have an increased risk of all-cause mortality (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.01 to 1.57) and CVD mortality (OR = 1.43; 95% CI = 1.00 to 2.05).4 The global prevalence of ED has been estimated to range from 3%–76.5%.4 A significant number of patients are known to suffer in isolation and do not seek help. Therefore, prevalence data are likely to be an underestimate.5 It is common for men with ED to experience anxiety, depression, relationship difficulties, and a lack of sexual confidence.2,3 These factors often lead to poorer quality of life for the sufferer, their partner, and family. Both pharmacological and non-pharmacological treatment options are available for the treatment of ED.

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The National Institute for Health and Care Excellence (NICE) in England recommends using phosphodiesterase type-five inhibitors (PDE-5I) as a firstline pharmacological treatment option for men with ED. Four PDE-5Is are currently licensed in the UK and include sildenafil, tadalafil, vardenafil, and avanafil.5 However, only sildenafil and tadalafil remain the drugs of choice. Sildenafil was reclassified in March 2018 by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) to ‘pharmacy-only’ medicine, which allowed community and online pharmacies to supply the drug to the patients without the need of a prescription.6 MHRA make decisions to alter the legal status of medicines in the UK from ‘prescription-only’ to ‘pharmacy’ or ‘general sales list’ categories (Table 1).7,8 The decision to reclassify such medicines are primarily based on safety data.7 Such reclassifications are often expected to reduce the volume of prescribing and costs from the perspective of the NHS as patients are required to pay the price of the medicines at the point of purchase. A cardiovascular risk assessment by a pharmacist in the community pharmacy is a prerequisite to pharmacy supply of sildenafil.9 Such risk assessment is undertaken using a series of questions asked to the patients before a supply can be made. Sildenafil is still available on NHS prescription along with tadalafil, vardenafil, and avanafil.

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There is a lack of research in relation to presentation and management of ED in primary care, particularly in the UK. To date, no longitudinal research has looked into the prescribing patterns and costs of PDE-5Is in English primary care settings. Given the association of ED with CVDs, including diabetes, vascular disorders, and mental health conditions,2,3,10 understanding any link that exists between deprivation and ED drugs prescribing trend will enable targeted interventions to manage comorbidities and reduce health inequality. The primary aim of this study was to investigate the trend in quantity and cost of prescribing of sildenafil and tadalafil in primary care settings in England between 2009 and 2019. Specific objectives related to the investigation of: a) whether a prescribing trend of ED drugs is associated with deprivation and demography of various English geographical regions; and b) whether the legal reclassification of sildenafil to ‘pharmacy-only’ medicine has impacted on the trend in quantity and cost of prescribing of ED drugs in England. of two ED drugs, sildenafil

• Legal regulations in Ireland restrict sildenafil sales without prescription.
• Low-cost sildenafil options are often found in online Irish pharmacies.
• Fake sildenafil is common online; verify seller credentials before purchase.
• Some clinics in Ireland offer subsidized sildenafil for specific conditions.
• Cost of sildenafil may include consultation or delivery fees in Ireland.

and tadalafil, within the

Month	Average Price (€)	% Change	Notes
January	13	-	Stabilized price
February	12.5	-3.8%	Slight decrease
March	12	-4.0%	Promotional discounts
April	11.5	-8.3%	Price drop due to competition
May	11.8	+2.6%	Slight increase

NHS England primary care

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* The college will be involved in preparing teachers who provide leadership and exemplary * Educational and related services in a changing and complex global scenario. To Provide quality training and shape our students to be readily deployable by the institutions, to meet the growing demands for trained man-power in the intrinsic competitive knowledge industry. College of Teacher Education (CTE),Tinsukia was started during the year 1993 at Tinsukia, Assam, India . This was started with the aim to impart quality Teacher education which focuses o Aspargo Labs’ oral suspension products enhance patient experiences and empower physicians to manage health outcomes more effectively. Administered orally, our formulations achieve a higher absorption rate.

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Our unique suspension technology optimizes the sildenafil 100mg hexal interplay between molecular particle size, coating, and viscosity, resulting in more efficient treatment delivery. Oral suspension formulations have several advantages including accelerated absorption rates, higher bioavailability, better taste, and are often preferred by patients who have difficulty swallowing. Aspargo Labs is at the forefront of developing a high-tech device with replaceable medication cartridges, which in the future will also be connected to a user-friendly mobile platform. These cartridges will be available for multiple medications across various therapeutic areas, and the device will provide real time data to benefit patients, physicians and caregivers. Optimizing the bioavailability of active ingredients in suspension technology for more efficient uptake Liquid formulations reduce the complexity of dosing schedules Ease of administration helps patients follow doctors recommendations leading to more consistent use Almost 40% of the population report having difficulty to swallow pills, especially for pediatric and geriatric populations Thanks to our proprietary technology, Aspargo Labs launched a liquid oral sildenafil suspension product (ASP-001) the active ingredient in Viagra®.

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Product is currently marketed under the brand names of HEZKUE® in Germany, UK and Ireland and BANDOL® in Spain. ASP-001 has also received regulatory approval in additional countries: Mexico, Netherlands and Argentina. Aspargo Labs has completed all clinical trails to satisfy the submission of an NDA with the FDA. Additional oral suspensions are in development for both Rx and OTC products. Background Sildenafil and tadalafil are recommended firstline treatments for erectile dysfunction (ED). settings between January 2009

• In Ireland, sildenafil costs can vary seasonally due to demand.
• Generics of sildenafil are typically 30-50% cheaper than branded versions.
• Bulk purchasing may provide savings on sildenafil in Ireland.
• Irish online pharmacies often provide discreet packaging at competitive prices.
• Prescription requirements impact the final price of sildenafil in Ireland.

and November 2019, was conducted.

Age Group	Preferred Price Range (€)	Brand Preference	Comments
20-40	8-12	Generics	Cost-effective, reliable brands
41-60	11-15	Name brands	Willing to pay more for brand
60+	9-13	Generics	Budget-conscious, stable prices