Online ED Markup vs Cost Plus: Sildenafil and Tadalafil per Dose
Online ED programs charge a median of about 18 times the Cost Plus Drugs tablet price for generic sildenafil. Our per-dose math, what the markup pays for.
By Julian Caraulani · Last updated
CostReviewed by Dr. A. Goher, MBBS
- FDA-approved and compounded
- LegitScript seal ID shown
- 49 states (not AR)
| Key figure | Markup | How we got it | Prices read |
|---|---|---|---|
| Generic sildenafil, median of 7 programs | 17.9x | Median per dose ($4.00) / Cost Plus per tablet ($0.223) | 31 Oct to 7 Nov 2026 |
| Generic sildenafil, with Cost Plus shipping | 8.0x | $4.00 / $0.50, the Cost Plus cost per tablet at 8 a month with shipping | 31 Oct to 7 Nov 2026 |
| As-needed generic tadalafil, median of 6 programs | 26.9x | Median per dose ($6.00) / Cost Plus per tablet ($0.223) | 7 Nov 2026 |
| Lowest program, generic sildenafil | 7.2x | Strut Health $1.60 / $0.223 | 6 Nov 2026 |
A markup here is a plain ratio: program price per dose divided by the Cost Plus price per tablet. It is not a profit margin. The program price buys more than a tablet, as the sections below show.
How much online ED programs mark up generic sildenafil
Each row is one program's lowest published per-dose price for generic sildenafil, the FDA-approved generic of Viagra. We divide it by the Cost Plus Drugs price for a 100 mg tablet, which includes its pharmacy fee and leaves out shipping. The markup columns are our arithmetic.
| Program | Plan | Per dose | Markup vs Cost Plus tablet | Markup vs Cost Plus with shipping | Read |
|---|---|---|---|---|---|
| Strut Health | 25 mg, 90-day supply of 30 doses | $1.60 | 7.2x | 3.2x | 6 Nov 2026 |
| Rex MD | 20 to 100 mg, packs of 6 to 12 | $1.80 | 8.1x | 3.6x | 7 Nov 2026 |
| Lemonaid Health | Generic sildenafil, plus a $25 consult once | $2.00 | 9.0x | 4.0x | 6 Nov 2026 |
| Ro | 25 mg, 8 doses a month | $4.00 | 17.9x | 8.0x | 7 Nov 2026 |
| Hims | Generic sildenafil, per use | $4.00 | 17.9x | 8.0x | 7 Nov 2026 |
| Idun Rx | 50 or 100 mg, 6 pills a month, 12-month plan | $6.00 | 26.9x | 12.1x | 7 Nov 2026 |
| PeterMD | 100 mg, pack of 30 tablets | $6.00 | 26.9x | 12.1x | 6 Nov 2026 |
| Cost Plus Drugs | 100 mg, 30 tablets, $6.69 a pack | $0.223 | 1x | 1x | 31 Oct 2026 |
"With shipping" spreads the Cost Plus shipping charge over 8 tablets a month, bought as packs of 30. That works out to about 50 cents a tablet, our arithmetic. The median of the seven programs is the Ro and Hims rows.
Tadalafil markup vs Cost Plus
Generic tadalafil is the FDA-approved generic of Cialis. The as-needed plans show a wider gap than sildenafil. We match each strength to the Cost Plus tablet of the same strength where the program names one.
| Program | Plan | Per dose | Cost Plus tablet used | Markup | Read |
|---|---|---|---|---|---|
| Strut Health | 5 mg, 90-day supply | $2.40 | 5 mg, $0.199 | 12.1x | 7 Nov 2026 |
| Rex MD | 10 to 20 mg, as needed | $6.00 | 20 mg, $0.223 | 26.9x | 7 Nov 2026 |
| Hims | Generic tadalafil, per use | $6.00 | 20 mg, $0.223 | 26.9x | 7 Nov 2026 |
| Idun Rx | 10 or 20 mg, 12-month plan | $6.00 | 20 mg, $0.223 | 26.9x | 7 Nov 2026 |
| PeterMD | 20 mg, pack of 30 | $6.33 | 20 mg, $0.223 | 28.4x | 7 Nov 2026 |
| Ro | 5 mg, as needed | $11.00 | 5 mg, $0.199 | 55.3x | 7 Nov 2026 |
Daily tadalafil plans sit much closer to Cost Plus. Rex MD and Idun Rx list it at $1.80 a dose and Lemonaid at $2. Against the Cost Plus tablet, that is about 9 to 10 times, our arithmetic. See daily tadalafil cost for the monthly totals.
- FDA-approved and compounded
- LegitScript seal ID shown
- 49 states (not AR)
Why are online ED meds more expensive?
A program price is not the price of a tablet alone. Most programs fold four things into it.
- The prescription. A licensed clinician reviews your answers and writes the prescription. Cost Plus Drugs needs a prescription you already have.
- Shipping. Most programs ship free. Cost Plus charges a standard shipping fee per order, set out in its pricing API documentation as "Standard shipping cost for 1 medication, cash-pay (USD)."
- Follow-ups and messaging. Most programs let you message a clinician about side effects or a dose change at no extra charge.
- Packaging and refills. Monthly or quarterly refills arrive without a new order.
Strut, for example, says its "Price includes healthcare provider consultations and free shipping." (Strut sildenafil page, read 14 November 2026). The Cost Plus documentation, by contrast, lists a price per unit "inclusive of CPD markup", with dispensing and shipping as separate fields (Cost Plus pricing API documentation, read 14 November 2026).
So the honest comparison adds a visit to the Cost Plus side. Our online ED visit cost guide shows what a one-off visit costs.
Telehealth vs Cost Plus price: what a study found
A Journal of Urology paper compared three direct-to-consumer ED pharmacies with Cost Plus Drugs. Its author told Urology Times that the cheapest sildenafil option at the programs "was compared with 15 cents per pill from Cost Plus Drug Company." He added: "2 out of 3 of the direct-to-consumer pharmacies require a 6- or 12-month commitment to obtain those prices, whereas Cost Plus Drug Company requires no long-term commitment." (Urology Times, read 14 November 2026).
The study looked at 2023 prices, and the program names were hidden. Our tables use today's named prices, read in November 2026. The pattern is the same: the gap is widest on as-needed tadalafil and narrowest on long sildenafil packs.
When the markup is worth paying
The markup buys convenience and care. It can make sense if:
- You do not have a doctor who will write an ED prescription.
- You want follow-up questions answered by message, not a new appointment.
- You value free shipping and refills that arrive on their own.
Cost Plus Drugs makes more sense if you already have a prescription, or can get one cheaply once a year. Then the tablets cost cents. Our Cost Plus Drugs guide lists every ED and hair loss price it shows.
A middle path exists. Ro says members "can choose to pick up medication at their own pharmacy" (Ro). Ask your program if it can send the prescription to a pharmacy you pick.
How we worked out the markup
- Program prices: the lowest per-dose price each program publishes for a plain generic, from site data read 6 and 7 November 2026. Monthly plans with no dose count are left out, since a per-dose price cannot be worked out.
- Cost Plus prices: the pack price for 30 tablets, with its pharmacy fee, divided by 30. Read 31 October (sildenafil) and 7 November 2026 (tadalafil).
- Median: the middle value of the programs' ratios. With seven sildenafil programs, it is the fourth.
- Not counted: compounded chews and mints. They mix drugs Cost Plus does not sell as one tablet, so there is no fair match. See compounded ED medication.
All ratios are our arithmetic from those dated reads. A program can change its price at any time; the live figures are on ED cost by program.
Questions
FAQ
how much online ed programs mark up generic sildenafil
At the median program, about 18 times the Cost Plus Drugs tablet price, by our arithmetic from prices read 31 October to 7 November 2026. The range runs from about 7 times at Strut Health to about 27 times at Idun Rx and PeterMD. Counting Cost Plus shipping, the median gap falls to about 8 times. The program price also includes the visit.
Why are online ED meds more expensive than Cost Plus?
Online programs include the clinician visit, free shipping, follow-up messages and automatic refills. Cost Plus Drugs sells only the tablet and needs a prescription you already have. Its pricing documentation lists a per-unit price, a dispensing fee and a shipping cost as separate items. The tablets are the same FDA-approved generics either way.
Is the telehealth vs Cost Plus price gap the same for tadalafil?
No, the gap is wider. As-needed generic tadalafil from the median program costs about 27 times the Cost Plus tablet, by our arithmetic. Daily tadalafil plans sit much closer, at about 9 to 10 times. Ro's 5 mg as-needed price shows the widest gap in our tables.
Can I use an online visit and fill at Cost Plus Drugs?
Sometimes. Cost Plus Drugs needs a prescription sent to it by a clinician. Some programs say they can send a prescription to a pharmacy you choose, and pay-per-visit services such as Sesame and Lemonaid write one for a single fee. Ask before you pay, since many programs only fill through their own pharmacy.
Which online ED program has the lowest markup?
Strut Health, at about 7 times the Cost Plus tablet price for generic sildenafil on its 90-day supply, by our arithmetic from prices read 6 November 2026. Rex MD and Lemonaid follow closely. The live lowest per-dose price is $1.60 at Strut Health.
Are Cost Plus ED pills the same as the ones online programs send?
Yes, for plain generics. Generic sildenafil and tadalafil tablets are FDA-approved wherever they are filled. The FDA says "Generic drugs are FDA-approved copies of brand drugs." Compounded chews, mints and dissolving tablets are a different product and are not FDA-approved. Compare every program's live price on ED cost by program, or see how each one scores on our best ED programs.
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