Sexual health, prescribed online, state by state

Yes, in every US state and Washington, D.C. You complete a short online intake — the five-question erectile function index clinicians use (the IIEF-5), your heart and blood-pressure history, and every medication you take — and a clinician licensed in your state reviews it. When clinically appropriate, they prescribe sildenafil or tadalafil in the regimen and strength they judge right for you; nothing is charged unless they do, and your prescription ships free and discreet from a US-licensed pharmacy.

Usually not. 45 of 50 states let a licensed clinician establish care and prescribe by secure message, with no video call. Arkansas, Louisiana, Mississippi, Rhode Island, and West Virginia require one live video visit first; after it, care continues by secure message. Your state's page says which applies.

Sildenafil and tadalafil through Pallas starts at $57 for six tablets of sildenafil or tadalafil a month, or $126 for 18 tablets every 3 months — $42 a month; the compounded tadalafil / sildenafil tablet starts at $72 for six, and a 5 mg daily tadalafil tablet is $57 a month or $27 a month on a 6-month supply. Bigger bottles cost less per tablet. The price includes your US-licensed clinician, check-ins and care-team messaging, and free shipping; each supply renews on its own schedule — monthly or every 3 months (the daily tablet also every 6 months) — until you cancel, is charged only once a clinician prescribes, is cash-pay and not billed to insurance, and costs the same in every state.

No. Sildenafil and tadalafil are prescription medicines everywhere in the US. A legitimate telehealth service can name the licensed clinician who reviewed you and the licensed pharmacy that filled your prescription; a site that sells "sildenafil" with neither is selling unapproved, unverified product — there is no way to know what's in the tablet or how much. Price, reviews and a clinical-looking website don't change that.

Men taking nitrates in any form — nitroglycerin, isosorbide mononitrate or dinitrate — or riociguat: that combination is a contraindication on every PDE5 inhibitor's label because it can cause a dangerous drop in blood pressure. Beyond it, a clinician weighs alpha-blockers and blood-pressure medicines, recent heart events or chest pain with exertion, severe liver or kidney disease, retinitis pigmentosa or a prior episode of sudden vision loss, sickle cell disease, bleeding disorders, and conditions like Peyronie's disease. Those are screening questions, not automatic answers — the clinician decides, and if treatment isn't right for you, you're told plainly and nothing is charged.

Sildenafil and tadalafil tablets are filled by US-licensed pharmacies; which preparation your pharmacy dispenses is decided per prescription. The tadalafil + sildenafil combination tablet is compounded per-patient by a state-licensed pharmacy, and compounded preparations are not FDA-approved. That is why every prescription starts with a US-licensed clinician who reviews your health history and prescribes only when clinically appropriate.

Yes. Once a clinician prescribes, a US-licensed partner pharmacy fills your prescription and ships it free and discreet, with tracking, typically within two to three business days of filling it (three to five to Alaska and Hawaii).