Two drugs are approved in the United States for low sexual desire in women. One is a nightly tablet. One is an injection taken when it is wanted. That difference decides the bill more than the sticker does. The prices below come from each maker’s own page, and the Vyleesi cost page carries the brand’s terms in full.
| Vyleesi (bremelanotide) | Addyi (flibanserin) | |
|---|---|---|
| How it is taken | One injection, as needed | One tablet, every night |
| Cash price | $99 per 4-dose box | $149 per month |
| With commercial coverage | As little as $0, up to 2 fills every 30 days | As little as $20 per month |
| Government plans | Not eligible for the copay program | Not stated on the maker's page |
| Label ceiling | 8 doses a month | 1 100 mg tablet a day |
Putting a box on the same line as a month
A box is not a month. Vyleesi is dosed as needed, so the monthly bill depends on the count.
Dividing the cash box price by its 4 doses gives $24.75 a dose. That division is this page’s arithmetic. The maker prints the box price only.
Boxes do not divide, though. A cash month costs $99 for the first 4 doses, then $198 for the next 4.
So the crossover is a step, not a slope. A cash payer passes Addyi's $149 month at 5 doses. The label does not recommend more than 8 doses a month[1]. That caps the cash figure at $198, across 2 boxes.
So the cheaper drug depends on frequency, not on the headline. Fees around either one are added in the all-in monthly calculator.
Who each drug is approved for
Vyleesi is indicated for premenopausal women with acquired, generalized hypoactive sexual desire disorder[1]. It is not indicated in postmenopausal women, not in men, and not to enhance sexual performance[1].
Addyi is indicated for women under 65 with the same diagnosis[4]. It is not indicated in men or to enhance performance either[4].
Both labels set the same stopping rule. Vyleesi is discontinued after 8 weeks without improvement[1]; Addyi is discontinued after 8 weeks without improvement[4].
What the tablet asks of a night out
Addyi carries a boxed warning[4]. Taking it with alcohol close in time raises the risk of severe low blood pressure and fainting[4].
The label tells patients to wait at least two hours after one or two drinks[4]. After three or more, it says to skip that night’s dose[4]. It is contraindicated with moderate or strong CYP3A4 inhibitors and in hepatic impairment[4].
Vyleesi has its own condition attached. Focal skin darkening was reported in 1% of patients taking up to 8 doses a month[1]. Resolution was not confirmed in all of them[1].
What the trials measured, and how big the numbers were
Vyleesi’s two identical phase 3 trials randomized 1,267 premenopausal women for 24 weeks[5]. Across both, desire on the Female Sexual Function Index rose 0.35 against placebo, and related distress fell 0.33[5].
Nausea, flushing and headache each hit 10% or more in both trials[5]. The trials were funded by the drug’s developers[5].
Flibanserin was pooled across 8 studies and 5,914 women[6]. At 100 mg it added 0.49 satisfying sexual events a month against placebo[6]. The 95% confidence interval ran from 0.32 to 0.67[6].
The same review put the risk ratio for stopping because of side effects at 2.19[6]. It put dizziness at 4.00 and somnolence at 3.97[6]. Its authors summarized the benefit as one-half of an extra event a month[6].
Why a state plan is rarely the answer here
Federal law lets a state Medicaid program exclude agents used to treat sexual dysfunction[7]. The exception is narrow: an agent used for another condition FDA approved it for[7].
Neither drug has a second indication to fall back on. That is why both makers’ help programs are written for commercial coverage and cash.
The compounded option is a different product
Bremelanotide is also compounded and sold by prescription, priced on the PT-141 board. A compounded vial is not Vyleesi, and it has not been reviewed by FDA for safety, effectiveness or quality.
What that market charges is in PT-141 cost. The nasal version is priced in PT-141 nasal spray. The prescribing route is in PT-141 prescription.