You can get ED medication online through Bidwell Health for a flat $45 visit fee, with no insurance required and no subscription. A U.S.-licensed nurse practitioner reviews your intake and, if clinically appropriate after cardiovascular screening, sends a prescription — typically generic sildenafil (Viagra) or tadalafil (Cialis) — electronically to your pharmacy. Most patients have their medication in hand within two hours during business days.
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+ qualify for async 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 Levitra). 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 provider 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 Levitra) | 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 flat (medication $10–100 at your pharmacy) | $150–300 for urgent care; $200+ for men's-health clinics |
| Wait time | Under 2 hours, same-day review | Days to weeks for appointment |
| Subscription required | No — one-time $45 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 nurse practitioners 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 nurse practitioners hold active, autonomous-practice licensure in 12 states — Arizona, Colorado, Connecticut, Florida, Iowa, Maryland, Montana, New Mexico, New York, Utah, Virginia, and Washington. State-by-state licenses are publicly verifiable through each state's board of nursing. 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 async 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.
Most intakes are reviewed by a licensed nurse practitioner within two hours during business days. Once the provider approves, your prescription is e-prescribed to your chosen pharmacy and is typically ready for pickup within another hour. Weekend and holiday turnaround can run longer — we tell you before you pay if review times are stretching.
$45 flat for the visit. Medication billed separately at your pharmacy — generic sildenafil (Viagra) runs $10–50 for 30 doses, generic tadalafil (Cialis) $10–60, daily low-dose tadalafil $20–80/month, generic vardenafil $30–100. No insurance required, no subscription — and no men's-health-platform monthly fee either.
Every intake is reviewed by a U.S.-licensed nurse practitioner. Our clinicians are AANP board-certified Family Nurse Practitioners credentialed through your state's board of nursing, operating under autonomous-practice authority. No rules engine, no auto-approval — a human reads the intake line by line before anything is prescribed.
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 don't treat async, an unclear differential, or a medication interaction — we tell you, refund your $45 automatically, and direct you to the appropriate in-person option. You don't pay for care that shouldn't be delivered through async telehealth.
No. Bidwell Health is cash-pay only. The $45 flat fee covers the clinical review and, if appropriate, the prescription. 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 — AUA guidelines support PDE5 inhibitors as first-line treatment. Our intake screens for contraindications; if you qualify, a licensed NP sends a prescription to your pharmacy.
Sildenafil (Viagra) works in 30–60 minutes, lasts 4–5 hours, is best on an empty stomach. Tadalafil (Cialis) works in 30 min–2 hrs, lasts up to 36 hours, less food-sensitive. Tadalafil can also be taken daily at a low dose.
Generic sildenafil is typically $15–$40 for a 30-day supply with GoodRx. Generic tadalafil runs $20–$60. Brand-name Viagra and Cialis are $70+/pill but generic is clinically identical.
Well-controlled hypertension is generally compatible with PDE5 inhibitors. Severe or uncontrolled hypertension (over 170/100) is a contraindication — see your primary care first to get it controlled.
Moderate alcohol is usually fine with PDE5 inhibitors, but heavy drinking reduces effectiveness and increases side effects like flushing and headache. AUA recommends moderation.
Roughly 70% of men respond to the first PDE5 inhibitor they try. If it doesn't work: make sure you took it correctly (empty stomach for sildenafil, enough lead time, adequate sexual stimulation), try a different agent, or try a higher dose. If still unresponsive after two agents, see a urologist — you may benefit from second-line therapy or testosterone evaluation.
Prescriptions go to the pharmacy of your choice. Most pharmacies bag medications privately; online delivery options are available through most major chains if you want extra discretion.
No — psychogenic ED (anxiety, depression, relationship stress) is common, especially in men under 40. PDE5 inhibitors often help psychogenic ED too, and many men benefit from combining medication with behavioral or couples therapy.
Bidwell is cash-pay only — $45 flat for the visit. Most insurance plans don't cover ED medications regardless; generic sildenafil or tadalafil with GoodRx is usually cheaper than a copay.
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.