Get evaluated online for ED medication without a required subscription or video visit. Bidwell Health offers $45 online ED visits with no insurance billing. A U.S.-licensed clinician reviews your health history, medications, blood pressure and cardiovascular safety factors, then sends a prescription to your chosen pharmacy when clinically appropriate. Pharmacy pickup timing varies.
Bidwell Health quick facts: Bidwell Health is a cash-pay telehealth practice offering $45 online visits for eligible adults ages 18-64 in 11 states: Arizona, Colorado, Connecticut, Florida, Iowa, Maryland, Montana, New Mexico, Utah, Virginia, and Washington. No insurance or subscription is required. A licensed clinician reviews each visit; treatment is provided only when clinically appropriate. Bidwell is not for emergencies.
Online ED treatment may be a fit for adults with erectile dysfunction symptoms who do not have medication interactions or cardiovascular red flags that would make ED medication unsafe.
Online ED treatment may not be appropriate with nitrate use, certain heart conditions, chest pain, recent heart attack or stroke, severe uncontrolled blood pressure, serious medication interactions, severe liver or kidney disease, or symptoms that need urgent or in-person evaluation.
Erectile dysfunction (ICD-10 F52.21) is the consistent inability to achieve or maintain an erection adequate for satisfactory sexual performance. ED affects roughly 1 in 3 men at some point; prevalence increases steadily with age. Per the American Urological Association (AUA) guideline on ED, causes are typically vascular (atherosclerosis, diabetes), neurologic (MS, prostate surgery, spinal injury), hormonal (low testosterone), medication-related (some antidepressants, antihypertensives), or psychogenic (stress, anxiety, depression).
AUA guidelines classify PDE5 inhibitors — sildenafil, tadalafil, vardenafil, avanafil — as first-line treatment for ED, with lifestyle modification (exercise, smoking cessation, blood-sugar control) as a foundational co-intervention. Second-line therapies include intraurethral or intracavernosal alprostadil, vacuum erection devices, and penile implants for patients who don't respond to oral agents.
Adult men 18-64 qualify for online ED treatment if there is no current nitrate use, no recent myocardial infarction, stroke, or life-threatening arrhythmia within the last six months, and no severe uncontrolled cardiovascular disease. Sudden-onset ED in men under 40 and suspected low-testosterone symptoms warrant in-person evaluation. Common ED patterns include:
You qualify for a Bidwell telehealth ED visit if you are:
AUA guidelines list three first-line PDE5 inhibitors for erectile dysfunction: sildenafil (generic Viagra), tadalafil (generic Cialis) on-demand or daily low-dose, and vardenafil (generic; brand Levitra discontinued in the U.S.). All three require cardiovascular risk assessment before the first prescription and are absolutely contraindicated with nitrates or nitric oxide donors. In detail:
We do not prescribe testosterone without lab work; we do not prescribe avanafil (Stendra) if patients haven't tried sildenafil or tadalafil first (it's rarely cheaper and rarely necessary). We don't offer compounded "trimix" injections or intraurethral alprostadil — those are second-line therapies that benefit from urology management.
ED is often multifactorial. Vascular disease, medication side effects (especially SSRIs and certain antihypertensives), psychogenic factors, hormonal causes like low testosterone, and neurogenic injury from pelvic surgery can each contribute — and they often coexist. The underlying driver shapes whether a PDE5 inhibitor is sufficient or whether cardiology or urology workup is needed first. Here's how subtypes typically differ:
| Subtype | Telltale feature | Primary approach |
|---|---|---|
| Vascular ED | Gradual onset, loss of nocturnal erections, cardiovascular risk factors | PDE5 inhibitor + cardiovascular risk management |
| Psychogenic ED | Sudden onset, situational (OK with masturbation or certain partners), preserved nocturnal erections | PDE5 inhibitor + consider therapy referral |
| Medication-induced | ED started shortly after an SSRI, finasteride, beta-blocker, or thiazide | Review with prescriber; PDE5 may help |
| Hormonal (low T) | Low libido, fatigue, muscle loss, depression alongside ED | Lab workup — in-person |
| Neurogenic | After pelvic surgery, spinal injury, diabetes with neuropathy | Urology referral; PDE5 may or may not help |
| Peyronie's disease | Penile curvature, palpable plaque, painful erections | Urology referral |
Our intake asks the specific history needed to distinguish these. If your answers suggest something beyond uncomplicated ED, we'll say so and refund the visit.
AUA first-line PDE5 inhibitors for ED: sildenafil 25–100 mg on-demand, tadalafil 10–20 mg on-demand or 2.5–5 mg daily, or vardenafil 10–20 mg on-demand. All three require cardiovascular risk assessment and are contraindicated with nitrates. Your clinician picks based on desired duration, drug interactions, and any prior side-effect history.
| Medication | Onset / duration | Typical dosing | Key notes | Cash price (30 doses) |
|---|---|---|---|---|
| Sildenafil (generic Viagra) | 30–60 min onset, 4–6 h duration | 25 / 50 / 100 mg on-demand | Take on empty stomach for fastest onset | $10–50 |
| Tadalafil on-demand | 30 min onset, up to 36 h duration | 10 / 20 mg on-demand | Spontaneity through the weekend; food does not meaningfully affect absorption | $10–60 |
| Tadalafil daily | Continuous low-dose | 2.5 / 5 mg once daily | Removes the need to plan around a dose; also treats BPH symptoms | $20–80 / month |
| Vardenafil (generic; brand Levitra discontinued in the U.S.) | 30 min onset, 4–6 h duration | 10 / 20 mg on-demand | Alternative when sildenafil or tadalafil aren't tolerated | $30–100 |
| Factor | Bidwell Health | Clinic / urgent care |
|---|---|---|
| Visit cost | $45 online visit; medication paid separately | Often higher cash price for urgent care or specialty clinics |
| Wait time | Online clinician review | Days to weeks for appointment |
| Subscription required | No required subscription — one-time cash-pay visit | Often yes at subscription men's-health platforms |
| Insurance required | No | Usually, or high cash price |
| Prescription delivery | Electronic to any pharmacy you choose | Paper or e-prescription |
| Follow-up | Secure messaging inside the portal | Schedule a new visit |
For uncomplicated ED in men without cardiovascular contraindications, our clinicians typically start with either sildenafil 50 mg on-demand or tadalafil 10 mg on-demand as first-line — both are generic, well-tolerated, and high-efficacy. Which one we pick usually comes down to duration preference: sildenafil for a planned encounter within a few hours, tadalafil for more flexible timing across 24 to 36 hours. We raise the idea of daily low-dose tadalafil (2.5–5 mg) for patients who prefer continuous function without timing doses — especially those with concurrent benign prostatic hyperplasia. We do not dispense ED medication when nitrates are on board, when recent cardiac events are present, or when the history suggests vascular, hormonal, or neurogenic ED that needs workup beyond a prescription.
Bidwell Health's clinicians hold active clinical licensure in 11 states — Arizona, Colorado, Connecticut, Florida, Iowa, Maryland, Montana, New Mexico, Utah, Virginia, and Washington. Clinician credentials are independently verifiable through state license lookup systems. Select your state:
Please establish with a primary care provider, urologist, or cardiologist — either alongside or instead of a telehealth visit — if any of the following situations apply. These need an in-person exam, lab workup, or cardiovascular evaluation that online telehealth can't safely provide, and they change the appropriate starting treatment:
Yes, for uncomplicated erectile dysfunction in adult men who are not taking nitrates or nitric oxide donors, have no recent cardiovascular events, and whose cardiovascular risk is well-controlled. Per AUA guidelines, PDE5 inhibitors (sildenafil, tadalafil, vardenafil) are first-line pharmacotherapy after cardiovascular risk assessment. Sudden-onset ED under age 40, severe cardiovascular disease, recent MI or stroke, and Peyronie's disease require in-person evaluation.
Yes, if clinically appropriate after clinician review. Bidwell Health does not require a monthly medication plan or subscription for ED visits.
Yes, if tadalafil is appropriate for your medical history and medication list. Your clinician reviews safety factors first, then sends the prescription only when appropriate.
A licensed clinician reviews each intake 7 days a week, including weekends. When treatment is appropriate, your prescription is e-prescribed to your chosen pharmacy. Pharmacy pickup timing varies. Weekend and holiday turnaround can run longer.
Yes. If treatment is appropriate, your ED prescription is sent electronically to the pharmacy you choose during intake.
The online visit is $45. Medication is billed separately at your pharmacy; generic pricing varies by medication, dose, pharmacy, and discount program.
No. Bidwell Health is cash-pay only, with a $45 one-time online visit, no insurance billing, no required subscription, and no scheduled video visit required. The intake is reviewed online by a licensed clinician.
Every intake is reviewed by a licensed clinician credentialed in the state where care is requested. Clinician credentials are public and independently verifiable.
We don't dispense ED medication when any of the following apply: concurrent nitrate or nitric oxide donor use (absolute contraindication), recent heart attack, stroke, or life-threatening arrhythmia (within six months), severe cardiovascular disease (NYHA class III or IV), sudden-onset ED under age 40, history of priapism, Peyronie's disease symptoms, retinitis pigmentosa, or symptoms of low testosterone. Those need cardiology or urology workup.
If your intake surfaces any contraindication — a red-flag symptom, a condition we do not treat online, an unclear differential, or a medication interaction — we tell you, refund your visit fee automatically, and direct you to the appropriate in-person option. You don't pay for care that shouldn't be delivered through online telehealth.
No. Bidwell Health is cash-pay only. The $45 online visit covers clinical review and, if appropriate, the prescription decision. You can pay with HSA/FSA funds. Because we don't bill insurance, your visit doesn't appear on your explanation of benefits or family insurance claims — which many patients prefer for privacy reasons.
Yes, eligible adults may be able to get sildenafil online after licensed clinician review. If appropriate, the prescription is sent to the patient’s chosen pharmacy. Read the short answer.
Yes, eligible adults may be able to get tadalafil online after licensed clinician review. If appropriate, the prescription is sent to the patient’s chosen pharmacy. Read the short answer.
Yes. When treatment is clinically appropriate, Bidwell Health sends ED prescriptions electronically to the pharmacy chosen during intake.
Sildenafil usually works for a shorter window and is often used before planned sexual activity. Tadalafil lasts longer and may be used as-needed or daily when clinically appropriate.
ED medications are not appropriate with nitrates, certain serious heart conditions, recent heart attack or stroke, severe uncontrolled blood pressure, or medication interactions that make treatment unsafe.
Some adults with typical ED symptoms and no cardiovascular red flags can be evaluated online, but ED can signal cardiovascular, metabolic, hormonal, or medication-related issues that may need in-person follow-up.
No. Bidwell Health is cash-pay only. The online visit is $45, and medication cost is paid separately at the pharmacy.
Medication-induced ED is the most-missed cause in men under 45. Before reaching for a PDE5 inhibitor, we ask about any new medications started in the last year — particularly SSRIs (sertraline, escitalopram, fluoxetine, paroxetine), certain antihypertensives (beta-blockers, thiazide diuretics), and 5-alpha-reductase inhibitors started for other indications. If the ED timeline matches a medication start, a conversation with the prescribing provider about alternatives (bupropion instead of an SSRI is the classic swap, since it tends to be sexual-function neutral or improving) often resolves the issue without adding a second drug.
New ED in a man under 40 is a cardiovascular warning sign. ED precedes a cardiac event by 3–5 years on average in men with vascular disease — the penile arteries are smaller and show endothelial dysfunction earlier than the coronaries. A man in his 30s presenting with new ED deserves blood-pressure screening, fasting glucose, lipid panel, and an honest conversation about sleep, weight, and activity. PDE5 inhibitors help the symptom; they don't address the underlying driver.
Psychogenic vs. vascular has a telltale. Preserved morning erections and situational ED (fine with masturbation or some partners, not others) strongly suggest a psychogenic driver. Uniform loss across all contexts including morning wakes tilts vascular. Both still respond to PDE5 inhibitors; the difference shapes whether we also suggest therapy, lifestyle change, or cardiology workup.