OBJECTIVES: The approval of sildenafil citrate as the first effective oral therapy for the treatment of erectile dysfunction (ED) was met with both anticipation of its potential benefits and concern regarding its potential costs to employers and health plans. Health plan executives and employer healthcare professionals were asked to determine what effect adding sildenafil to pharmacy formularies had on pharmacy benefit costs. METHODS: Utilizing their own pharmacy and medical claims data, a panel of health plan executives and employer healthcare professionals determined the actual cost increase incurred as well as other effects of adding coverage of sildenafil to pharmacy benefits. Per member per month (PMPM) cost was calculated as total cost to the plan divided by total membership distributed over 12 months. RESULTS: Panel members included 3 executives from health plans with 93,000 to 15 million members and 5 wellness and benefits specialists and corporate medical directors from companies employing 6000 to 150,000 employees. Actual PMPM costs associated with sildenafil addition to pharmacy formularies were $0.04, $0.05 or less, $0.09, and $0.21. Many of the companies sponsored men's health screening and educational programs in conjunction with introduction of sildenafil coverage. Adding sildenafil coverage and increasing the focus on men's health was associated with an increased use of the healthcare system by men resulting in earlier detection and treatment of underlying conditions that may contribute to ED including hypertension, diabetes, ischemic heart disease, dyslipidemia, depression, and prostate cancer. CONCLUSIONS: Although estimates as high as $1 PMPM were predicted, actual costs of sildenafil coverage were $0.05 PMPM or less at several companies. Additionally, assessment of ED provided an important opportunity for physicians to screen their patients for other, potentially serious medical conditions that otherwise may have gone undetected. This earlier disease detection may be associated with less expensive treatment and better outcome.