How the price of generic sildenafil 20 mg fell 92 percent

In November 2013, retail pharmacies paid an average of 65.9 cents for a generic 20 mg sildenafil tablet, according to the National Average Drug Acquisition Cost survey¹ that the Centers for Medicare & Medicaid Services runs for Medicaid. In October 2026 the latest NADAC files⁶ put the same tablet at 5.2 cents.

That is a fall of 92 percent. Thirty tablets went from $19.78 in ingredient cost to $1.55.

Sildenafil's record is unusual in two ways. The drug was already generic when the federal series began, yet most of its decline came after 2016. And the 20 mg tablet sits under a different FDA application from the higher strengths of the same molecule, whose own generic launches came between 2016 and 2018. GxRadar analyzed CMS NADAC files from November 2013 through October 2026 and FDA approval records for both sets of strengths, and set the result beside tadalafil, a drug in the same class whose generic price fell far faster.

Thirteen years of one tablet's cost

Each figure is GxRadar's monthly median of the weekly NADAC per-tablet rate for generic-classified 20 mg sildenafil tablets. The table shows October of each year and the first month of the series. The full monthly series is on our sildenafil page.

Source: GxRadar analysis of CMS NADAC weekly files, November 2013 to October 2026. Generic-classified rows only. Ingredient cost only, not adjusted for inflation.

The price barely moved in the first year and was still above 44 cents in October 2016. The next three years did most of the work. Between October 2016 and October 2019 the price fell 65 percent, with one-month drops of 16 percent in May 2017, according to the 2017 NADAC files², and 29 percent in February 2019, according to the 2019 files³.

Two applications, two generic launches

The 20 mg tablet and the 25, 50 and 100 mg tablets are the same active ingredient, sildenafil citrate, sold under separate new drug applications. FDA approved the 20 mg tablet in June 2005, and its labeling covers pulmonary arterial hypertension, according to the FDA label record for that application⁹. The higher strengths sit on an application approved in March 1998.

GxRadar counted approved abbreviated new drug applications (ANDAs) for each strength in FDA's Drugs@FDA data, queried through openFDA⁸, leaving out tentative approvals.

Source: GxRadar count from the openFDA record for sildenafil citrate⁸, downloaded November 2026.

For more than three years after November 2012, every approved generic sildenafil tablet was a 20 mg tablet, and over that time its price eased only slowly. The first generic 25, 50 and 100 mg tablets were approved under a single ANDA in March 2016, and four more ANDAs covering the 100 mg tablet followed on June 11, 2018. The steep part of the decline, from late 2016 to early 2019, overlaps with the period in which FDA approved the first generic versions of the higher strengths. The NADAC files record invoice prices and nothing about why they change, and the higher-strength tablets are separate products with their own NADAC rates, so the overlap shows timing only. It does not establish a cause.

Researchers have documented the broader pattern. FDA economists reported in a 2019 analysis¹⁰ that generic prices fell further as the number of makers grew, reaching more than 95 percent below the pre-entry brand price with six or more. Our explainer on why generic prices fall as competitors enter walks through that research.

How tadalafil compares

Tadalafil 5 mg, a drug in the same class, went generic much later and fell much faster. Its first generic NADAC rate, in December 2018, was $8.26 per tablet. FDA approved 15 ANDAs for the 5 mg tablet on a single day, March 26, 2019, per the openFDA record for tadalafil⁸. The price stayed near $8 through May ($7.86 that month), fell to $4.29 in June and dropped to 52 cents in July 2019, an 88 percent fall in one month.

Source: GxRadar analysis of CMS NADAC files and FDA Drugs@FDA via openFDA.

Tadalafil's single-day wave of approvals is what a crowded launch looks like, and its price collapsed within months. Sildenafil 20 mg came to market with fewer competitors and took years to reach a comparable discount. Our piece on how fast prices fell for rosuvastatin, duloxetine and tadalafil follows tadalafil's first two years month by month.

A jumpy 2024 and a quieter 2026

By average month-to-month change, sildenafil 20 mg was the most volatile of the 47 generics GxRadar tracks in 2024, a year covered in our account of the 2024 NADAC swings. The monthly figure ranged from 5.2 to 9.7 cents that year and moved by a quarter or more in five separate months, rising 33 percent in January, 26 percent in June and 26 percent in September, and falling 25 percent in July and 27 percent in November, according to the 2024 NADAC files⁴.

CMS attributed that kind of swing to fluctuations in pharmacy participation in its monthly survey and, from the December 2024 updates, began calculating generic rates as a three-month moving average, according to its December 2024 methodology⁷. The same swings show up across the GxRadar generic price index.

Smoothing did not freeze the price. The figure climbed from 6.0 cents in January 2025 to 7.7 cents in August, according to the 2025 files⁵, then fell back to 5.5 cents by December. Through 2026 it has drifted between 5.1 and 5.5 cents, reaching a series low of 5.10 cents in September. Those are ingredient costs only. What a patient pays also depends on dispensing fees, markups and coverage, which our explainer on what NADAC measures describes, and the GxRadar price pages carry the current monthly series.