The real cost of online ED treatment: twelve subscription services and a $45 visit, compared over a year

The short answer

Generic sildenafil and tadalafil are among the cheapest prescription drugs sold in the United States. On 5 September 2026, Cost Plus Drugs listed 30 tablets of sildenafil 50 mg for $6.36, 30 tablets of tadalafil 20 mg for $6.69 and 30 tablets of tadalafil 5 mg for $5.97, plus $5.25 shipping. A GoodRx coupon priced the same generics at roughly $8 to $17 a pack at a retail pharmacy. The subscription services sell the same tablets for $1.50 to $44 a dose.

Over a year, that is the difference between a bill that is mostly medicine and a bill that is mostly subscription. The standard Bidwell Health ED prescription is written for six months: 45 tablets plus one refill, which is 15 tablets a month. At that quantity, a year of sildenafil is $780 to $1,140 at Hims, $1,080 at Ro, Rex MD and Peter MD, about $720 at BlueChew, and about $160 with two $45 Bidwell Health visits and Cost Plus Drugs, or $248 to $397 with a coupon at a chain: 49 to 86 percent less than the big brands. A year of tadalafil 20 mg at 15 a month is $7,920 at Ro and $1,230 to $2,265 at Hims against about $162 to $259: 79 to 98 percent less. For daily tadalafil it is Hims $389 to $1,008, Rex MD $730, BlueChew about $874, Ro $2,920, against about $235 to $255: 34 to 92 percent less. Of what you pay the four big brands over a year, between 64 and 98 percent is not medicine. The tables show the work, including the two discount subscriptions that are cheaper than a chain-pharmacy coupon at the small quantities they advertise, and the per-visit services that charge less than we do for the visit itself.

1. What the pills actually cost

Retail-pharmacy coupon prices and mail-order prices for the five generic products every service on this page sells. Cost Plus Drugs prices were read on its product pages on 5 September 2026 and are itemised there as manufacturing cost plus 15 percent plus a $5 pharmacy fee; standard shipping is $5.25 per order. GoodRx figures are free-coupon prices on 5 September (the site defaulted to a Columbus, Ohio ZIP code; yours will differ by a few dollars). SingleCare figures are its published coupon prices with the pharmacy and date shown.

Sesame's prescription savings card quotes sildenafil 100 mg at $15 for 10 and tadalafil 5 mg at $18.50 for 30. Cost Plus Drugs is a licensed mail-order pharmacy that fills any prescriber's e-prescription and does not offer telehealth; a Bidwell Health prescription can be sent there directly. Cost Plus fills the quantity prescribed, and the $5 pharmacy fee and $5.25 shipping are per fill, so a 90-count prescription pays them a third as often.

2. What the subscription services charge per dose, and how far above the pharmacy that is

Sticker prices from each company's own pages on 5 September 2026 unless noted. "From", "as low as" and "starting at" are the companies' words and usually depend on plan length or quantity, which the pages do not always state. The markup columns compare each price with the GoodRx coupon price per dose (the range above) and with the Cost Plus Drugs price per dose including one $5.25 shipping fee on a 30-count fill ($0.39 sildenafil 50 mg, $0.40 tadalafil 20 mg, $0.37 tadalafil 5 mg).

3. What a year costs, and what you save

Everything included: medication, per-order fees, consult fees, and for Bidwell Health two $45 visits (the standard prescription is written for six months, so a year is two visits). Subscription figures use the monthly plan unless a range shows quarterly or annual prepay. The Bidwell coupon route uses the GoodRx prices in section 1; the Cost Plus route uses 30-count fills at $5.25 shipping each. Percentages are what you save against each service with the Bidwell route; where a service is cheaper the table says so.

At the standard Bidwell Health quantity: 15 tablets a month (180 a year)

The standard Bidwell Health ED prescription is 45 tablets plus one refill, 90 tablets, a six-month supply at 15 tablets a month. You can choose a smaller quantity at intake; the totals below use the standard. At pharmacy prices the quantity barely matters: nine extra sildenafil tablets a month cost about $3.50 through Cost Plus Drugs or $10 to $15 with a coupon. At subscription prices the quantity is the bill: the same nine tablets cost $54 more a month at Hims or Ro, and several services do not sell that many. Hims' plans stop at 16 doses a month, Rex MD's at 12, and BlueChew moves you to a 17-chew plan at $55 a month.

At the quantities the subscription services advertise: 6 sildenafil or 4 tadalafil a month

These are the tiers the services quote and the tiers most comparison articles use, so they are here for reference. They are also the only place on this page where two subscriptions beat the coupon route: at six tablets a month, Friday Plans and Rocket Rx are cheaper than a $45 visit plus chain-pharmacy sildenafil, because their per-pill premium on 72 tablets adds up to less than two visit fees. Neither beats the Cost Plus route, and neither is within 25 percent of it on tadalafil.

Tadalafil 5 mg daily (365 doses)

Daily tadalafil is where the subscription model is most exposed, because the tablet is the cheapest of the five and the services price it as if it were not. Ro's published price is $8 a dose for a tablet that costs 20 cents by mail and about 40 cents with a coupon. Hims gets within a dollar of the pharmacy price only if you pay $384 for the year up front. Nothing on this page, including the two discount subscriptions, comes within 50 percent of the cash-pay route on daily tadalafil.

4. The subscription tax

Take any year-long bill above, subtract what the same tablets cost at a pharmacy with a coupon, and what remains is the price of the subscription itself: the bundled "free" consultation, the shipping, the packaging and the margin. For the four largest brands that remainder is 64 to 84 percent of a sildenafil bill, 84 to 94 percent of an on-demand tadalafil bill, and 77 to 95 percent of a daily tadalafil bill. At Ro, 98 cents of every dollar spent on on-demand tadalafil is not the tadalafil. The discount subscriptions, Friday Plans and Rocket Rx, carry a much smaller tax on on-demand sildenafil (13 to 52 percent) and a large one on daily tadalafil (68 to 80 percent).

A one-time visit carries a tax too: the $45. Over a year it is 35 to 72 percent of the cash-pay bill depending on the drug, and it buys a clinician's review, the prescription with refills, and a refund if treatment is not appropriate. The difference is that it is paid twice a year, not twelve times, and it does not scale with how much medication you use.

5. The other per-visit services, compared honestly

Bidwell Health is not the only service that charges for the visit and sends the prescription to your pharmacy, and it is not the cheapest visit. The medication arithmetic is identical for all of these; the differences are the visit fee, how often you pay it, and what it includes.

If the visit price is the only thing that matters to you, Optum Store and Amazon One Medical are cheaper than we are, and a year with either of them plus a coupon will land within $40 of the Bidwell totals above. What $45 buys here is a six-month prescription at the standard 15 tablets a month, a same-day message-based review with no video, a named clinician, and a refund if we cannot treat you. That is worth $45 to us and to most of our patients; if it is not to you, use one of them rather than a subscription.

6. What the per-dose price does not tell you

The subscription services are cheap to start and expensive to leave. These terms are from each company's own terms, FAQ and support pages, read on 5 September 2026.

7. How the cash-pay route works

A Bidwell Health ED visit is a $45 online intake reviewed by a licensed clinician, with no scheduled video and no insurance billing. When treatment is clinically appropriate, the prescription is sent electronically to the pharmacy you choose, written for six months of supply at the standard 15 tablets a month (45 tablets plus one refill), so one visit covers six months and a year is two visits. Ask for 90-count fills and the pharmacy fee and shipping on a mail order are paid four times a year instead of twelve. That pharmacy can be a chain where you show a GoodRx or SingleCare coupon at the counter, a warehouse club, or Cost Plus Drugs, which mails the medication at the prices in section 1. If the intake shows treatment is not appropriate, the visit fee is refunded. There is no membership, nothing renews, and nothing ships from us. Details: online ED treatment and pricing.

8. When a subscription service is the better choice

This section is the reason to trust the tables. Hims, Ro and Rex MD serve all fifty states; Bidwell Health serves eleven. If you want medication at your door and never want to stand at a pharmacy counter or wait for the mail, the shipped model is what you are paying for. If you want a compounded chewable, mint or sublingual, a regular pharmacy cannot fill it and BlueChew, Hims, Ro, Rugiet, Eden or Rocket Rx can. Ro, Friday Plans and Rocket Rx will send a prescription to your own pharmacy if you ask, which makes them hybrids. For a few sildenafil tablets a month filled at a chain, Friday Plans at $1.99 a tablet and Rocket Rx from $1.50 are cheaper than a $45 visit plus coupon-priced tablets, because their per-pill premium on a handful of tablets adds up to less than two visit fees; at the 15 tablets a month we prescribe as standard they are roughly even with a chain coupon and about half again the cost of the Cost Plus Drugs route, and on tadalafil they are not close at any quantity. Both are subscriptions. If you are on a prepaid annual Hims daily-tadalafil plan, your per-dose price is within a dollar of the pharmacy price, though you paid for the year up front. And on the visit fee alone, Optum Store and Amazon One Medical are cheaper than we are.

9. How these prices were verified

Every competitor figure was read from the company's own pricing, product, terms, FAQ or support page on 5 September 2026, and the page is named in the cell or note. Where a company's own page would not show a price, the most recent third-party reading is used and labelled with its source and date (Innerbody's Hims review of 23 August 2026 for Hims' plan tiers; BlueChew's own blog for BlueChew's plan prices, since its plan page does not render them; Ro's review of Rugiet for Rugiet's one-time consult fee). Cost Plus Drugs prices were read on its product pages the same day. GoodRx prices are free-coupon figures, SingleCare prices its published coupon prices with pharmacy and date, and warehouse-club prices the posted cash prices. "From", "starting at" and "as low as" are the companies' own qualifiers and are reproduced as such. Twelve-month totals are arithmetic on those figures at the stated usage; they exclude sales tax and first-order promotions except where noted. Percentages compare the ranges shown; where a competitor is cheaper the table says so. Bidwell Health has no affiliate relationship with any company on this page and receives nothing when you buy from any of them. Prices are re-verified quarterly, or sooner when a company changes its published pricing; the verification date at the top is the date to trust.

The markup finding is not new. A 2024 analysis in The Journal of Sexual Medicine compared the direct-to-consumer services with Cost Plus Drugs and found introductory sildenafil at $4.17 to $6.50 per pill at BlueChew, Hims and Roman against $0.32 at Cost Plus, and tadalafil at $6.25 to $9.75 against $0.36, concluding that the markup "likely exceeds the out-of-pocket cost for a primary care office visit needed to obtain a prescription." That office visit is what the subscriptions bundle, and what a $45 telehealth visit replaces.

Vercnocke J, Zhong A, Liaw A, Ginsburg K. The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company. J Sex Med. 2024;21(Suppl 1):qdae001.154. doi:10.1093/jsxmed/qdae001.154

Questions people ask

What is the cheapest way to get ED medication online?

A one-time telehealth visit plus generic medication filled at your own pharmacy with a coupon, or mailed by Cost Plus Drugs. On 5 September 2026 Cost Plus listed 30 tablets of sildenafil 50 mg for $6.36, tadalafil 20 mg for $6.69 and tadalafil 5 mg for $5.97, plus $5.25 shipping; coupon prices at a retail pharmacy were roughly $8 to $17 a pack. The subscription services charge $1.50 to $44 a dose for the same generics.

How much more do Hims, Ro, Rex MD and BlueChew charge than a pharmacy?

For generic sildenafil 50 mg, Hims, Ro and Rex MD charge $6 a dose: 250 to 425 percent above a coupon price and about 15 times the Cost Plus Drugs price including shipping. For tadalafil 20 mg, Ro charges $44 a dose, roughly 4,600 to 5,100 percent above the coupon price. For daily tadalafil 5 mg, Ro charges $8 a dose against 40 to 46 cents with a coupon and 20 cents by mail.

What does a year of ED medication cost at Hims versus a $45 visit?

At six sildenafil doses a month, Hims costs $348 to $492 a year including its $5 per-order fee. Two $45 Bidwell Health visits plus generic sildenafil cost about $170 to $215 with a coupon, or about $125 through Cost Plus Drugs: 38 to 75 percent less. For daily tadalafil, Hims costs $389 to $1,008 depending on how much you prepay; the cash-pay route is about $235 to $255.

Is Friday Plans or Rocket Rx cheaper than a $45 visit plus a pharmacy?

Only at small quantities filled at a chain. Friday Plans sells any strength for $1.99 a tablet on a subscription and Rocket Rx from $1.50 plus $4.95 shipping per order. At six sildenafil tablets a month that is $143 and $167 a year, below a $45 visit plus coupon-priced tablets ($170 to $215) and above the Cost Plus Drugs route ($125). At the standard Bidwell Health quantity of 15 tablets a month, they are $358 and $329 against $248 to $397 with a coupon and about $160 through Cost Plus. On tadalafil 20 mg at 15 a month they are 28 to 53 percent more than the coupon route; on daily tadalafil, $726 and $516 against about $235 to $255.

Can I get ED medication online without a subscription?

Yes. Bidwell Health charges $45 for a one-time visit, writes the standard prescription for six months, and sends it to any pharmacy you choose, including Cost Plus Drugs. Optum Store, Amazon One Medical, Sesame and PlushCare also charge per visit. Hims, Ro, Rex MD, BlueChew, Friday Plans, Strut, Eden, Rugiet and GoodRx Care sell medication on recurring plans.

Can my prescription go to Cost Plus Drugs?

Yes. Cost Plus Drugs is a licensed mail-order pharmacy that fills e-prescriptions from any prescriber; it does not offer telehealth itself. Enter Cost Plus Drugs as your pharmacy at intake and the prescription is sent there electronically. Its prices are itemised on each product page as the manufacturer's cost plus 15 percent plus a $5 pharmacy fee, with $5.25 standard shipping per order.

Can I cancel Hims, Ro, Rex MD or BlueChew any time?

Each allows cancellation with a deadline before the next charge: Hims at least two days before renewal, Ro 48 hours, Rocket Rx 48 hours, Strut 48 hours, Rugiet 48 hours, BlueChew 24 hours, GoodRx Care one day; Rex MD's terms say within 12 hours of the renewal date. Hims does not refund partly used periods, Rex MD's terms say all sales are final, and Strut and BlueChew do not accept returns of prescription treatments.

Does the $45 visit include the medication?

No. It covers clinician review, the prescription decision with refills, and messaging about the visit. Medication is paid at your pharmacy or to Cost Plus Drugs. If treatment is not clinically appropriate, the visit fee is refunded.

When is a coupon cheaper than telehealth for ED?

Whenever you already have a prescription. The coupon and Cost Plus prices above are what the pharmacy charges with or without a telehealth service in front of it. The visit is only the cost of getting the prescription, which is why a one-time $45 visit and a shipped subscription end up so far apart over a year.