What Tadalafil 20mg Tablets Cost Before and After Eli Lilly's Patent Expired

Tadalafil 20mg is the highest on-demand dose of the drug sold under the Cialis brand name. For the first fifteen years of its availability in the United States, it was sold exclusively as a brand-name product at a price that most patients paid entirely out of pocket. Understanding what drove that price and what changed in 2018 requires a brief look at how pharmaceutical patent protection works in practice.

Brand-Name Exclusivity: 2003 to 2018

Eli Lilly received FDA approval for Cialis on November 21, 2003. From that date until September 2018, tadalafil was sold in the United States only as the brand-name Cialis tablet. No generic equivalent was legally available, and no competing manufacturer could enter the market.

This exclusivity was protected by a compound patent — US Patent 5,859,006 — which covered tadalafil itself. During this period, the retail price for a single Cialis 20mg tablet at major US chain pharmacies ranged from approximately $60 to $80, depending on the pharmacy and year. A 30-tablet supply at the 20mg strength cost roughly $1,800 to $2,400 without insurance.

These prices reflected not physical manufacturing cost — tadalafil is not expensive to synthesize at scale — but rather recovery of research, development, and regulatory costs, combined with standard pharmaceutical pricing under a monopoly structure. Patent law intentionally creates this temporary monopoly as an incentive for drug development investment.

September 2018: The Generic Market Opens

Eli Lilly had entered a patent settlement in 2015 with Actavis (later acquired by Allergan, now part of AbbVie's portfolio) allowing generic tadalafil to enter the US market on September 27, 2018. On that date, Actavis launched an authorized generic version simultaneously with the brand at a price meaningfully below Cialis.

Under FDA's procedures, the first generic filer to challenge the patent successfully receives 180 days of generic exclusivity before additional manufacturers may enter. This exclusivity period typically still yields price reductions of 20–50% compared to the brand. Once multiple generics are available — which happened with tadalafil by early 2019 — prices can fall dramatically. A drug that cost $70 per tablet brand-name commonly reaches $5 per tablet or less once five or more manufacturers compete.

By 2020, generic tadalafil 20mg was available through independent and mail-order pharmacies at prices ranging from roughly $1.50 to $8 per tablet depending on quantity purchased and pharmacy type. Manufacturers with approved ANDAs for tadalafil include Actavis/Allergan, Aurobindo, Mylan, Teva, and Amneal, among others, all listed in the FDA Orange Book of approved drug products.

Brand Cialis: Still Available, Still Priced at a Premium

Following generic entry, Eli Lilly continued selling brand-name Cialis. Brand Cialis retained its distinctive yellow, almond-shaped, film-coated tablet with "C 20" imprinted on one side. List prices for brand Cialis remained high — in the range of $400–$500 for 30 tablets of the 5mg strength in subsequent years — even as generic versions undercut it substantially.

Patients who receive brand Cialis without a manufacturer savings program pay the brand list price. Manufacturer copay assistance programs are typically unavailable to patients covered by government insurance (Medicare, Medicaid), meaning the price difference has different implications depending on a patient's coverage status.

What Insurance Coverage Looks Like for This Medication

Most US commercial health plans and ACA marketplace plans exclude erectile dysfunction medications as a covered benefit under "lifestyle drug" or similar policy-level exclusions. Medicare Part D excludes these medications by federal statute — specifically, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 lists them among drugs not eligible for Part D reimbursement.

There is one meaningful exception: when tadalafil is prescribed specifically for benign prostatic hyperplasia (BPH, ICD-10 code N40.x) rather than erectile dysfunction, different coverage rules may apply. CMS has clarified in guidance that tadalafil prescribed for BPH may be covered under Part D plans. Men who qualify for both indications may find their prescription covered if the prescribing diagnosis is BPH.