Getting a prescription for Viagra (sildenafil) is straightforward. Most men get one from their primary care doctor, not a specialist. In fact, primary care providers write more than half of all sildenafil prescriptions. You don’t need a referral to a urologist unless initial treatment isn’t working.
What Happens at the Appointment
You can bring up erectile dysfunction at a routine checkup or schedule a visit specifically for it. The conversation is more common than you might think, and doctors are used to having it. Your doctor will ask about your symptoms, how long they’ve been happening, and how consistent the problem is. They’ll also review your medical history, current medications, and risk factors like high blood pressure, diabetes, or heart disease.
A physical exam is part of the process. This typically includes checking your blood pressure and may involve a brief genital exam. Your doctor may order blood work to rule out underlying causes like low testosterone, high cholesterol, or blood sugar issues. These conditions can contribute to erectile dysfunction and may need their own treatment.
Many doctors use a short questionnaire to gauge severity. One common version, the Sexual Health Inventory for Men, asks five questions scored on a scale. A total score of 22 to 25 suggests no ED, 17 to 21 indicates mild ED, 12 to 16 is mild-to-moderate, 8 to 11 is moderate, and 5 to 7 is severe. Your answers help the doctor decide whether medication is appropriate and what dose to start with.
Who Cannot Take Sildenafil
The most important safety concern is nitrate medications. If you take nitroglycerin patches, sublingual tablets, or any other nitrate-based drug for chest pain or heart conditions, sildenafil is off the table. The combination can cause a dangerous drop in blood pressure. Your doctor will review your full medication list before prescribing.
Severe liver disease, severe kidney disease, and certain heart conditions also require extra caution. In some cases your doctor may still prescribe sildenafil at a lower dose, but in others they’ll recommend a different approach entirely.
Starting Dose and How It Works
The standard starting dose for men under 65 is 50 mg, taken about an hour before sexual activity. It can be taken anywhere from 30 minutes to 4 hours beforehand. For men 65 and older, doctors typically start at 25 mg because the body clears the drug more slowly with age.
Your doctor may adjust the dose up or down based on how well it works and whether you experience side effects. Kidney or liver problems, certain other medications, and even grapefruit juice can affect how your body processes sildenafil, so be honest about everything you consume. The maximum is one dose per day.
Common Side Effects
The most frequently reported side effects in clinical trials were headache (16% of users compared to 4% on placebo), facial flushing (10% vs. 1%), and indigestion (7% vs. 2%). These tend to be mild and temporary. If side effects are bothersome, a lower dose often helps.
Telehealth Is a Valid Option
You don’t have to visit a doctor’s office in person. Telemedicine flexibilities for prescribing medications have been extended through 2026, and over 7 million prescriptions for controlled medications were issued via telehealth in 2024 alone without a prior in-person visit. Several online platforms connect you with licensed physicians who can evaluate your symptoms, ask the same screening questions, and send a prescription to your pharmacy if appropriate.
The process through telehealth usually involves filling out a health questionnaire, having a video or phone consultation, and receiving a prescription electronically. It’s particularly useful if you live in a rural area or simply prefer the privacy.
Cost: Generic vs. Brand Name
Generic sildenafil has made this medication dramatically more affordable. A typical 50 mg dose of generic sildenafil costs as little as 44 cents per pill when purchased in a 30-pill quantity. The same dose of brand-name Viagra costs over $67 per pill, putting a 30-day supply above $2,000.
The price drop has been steep. Between December 2017 and June 2021, the list price for six tablets of 100 mg generic sildenafil fell by 98%, from $265 to $4. Over that same period, brand-name Viagra’s price actually increased by 27%. There is no clinical difference between the generic and brand-name versions, so unless you have a specific reason, generic sildenafil is the practical choice.
Insurance Coverage Is Limited
Most insurance plans offer little help here. Medicare Part D specifically excludes coverage for drugs used to treat erectile dysfunction. This exclusion has been in place since 2007. Some private insurers do cover ED medications, but many don’t, or they require prior authorization and limit the number of pills per month.
The good news is that generic pricing has made insurance coverage less critical than it used to be. Pharmacy discount programs and coupons through services like GoodRx can bring the out-of-pocket cost down to just a few dollars. Ask your pharmacist about available discounts when you pick up the prescription.
If the First Prescription Doesn’t Work
Sildenafil doesn’t work for everyone on the first try, and that doesn’t mean it won’t work at all. Some men need a dose adjustment, better timing, or simply need to try it several times before seeing consistent results. Your doctor may increase the dose from 50 mg to 100 mg if the lower amount isn’t effective.
If sildenafil still isn’t producing results after proper adjustments, your primary care doctor will typically refer you to a urologist. Urologists have additional diagnostic tools and can offer alternative treatments. Most sildenafil failures seen by urologists were initially prescribed by primary care doctors, so this referral pathway is well established and routine.