Addyi, which was approved by the FDA in 2015, is now available over the phone for a new, lower price–but it's still not for everyone.
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A drug intended to increase women’s libido is back in the news, three years after it was approved by the U.S. Food and Drug Administration. Soon after Addyi hit the market in 2015, the drug’s parent company became mired in an unrelated scandal, and marketing of the new pill suffered. High cost and concern about side effects may have also kept women from signing on, and sales of the highly anticipated medication never took off as expected.

This week, the makers of Addyi reintroduced the drug to the market, with a new angle: It’s now available over the phone, and at half its original price. All of that sounds great, especially if you’re a woman who feels her sex drive could use a little boost. But the drug is not without controversy: Requirements for taking the drug are strict, and some experts question whether the condition it’s designed to treat is even a real thing.

To learn more about Addyi and low sexual desire, Health spoke with Stephen Snyder, MD, associate clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai and author of Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship. Here are the basics on this controversial pill, and why women may (or may not) want to pursue a prescription.

What is Addyi?

Addyi, whose generic name is flibanserin, is a daily pill approved to treat hypoactive low sexual desire disorder (HSDD) in premenopausal women. According to the drug’s website, women with HSDD have low sexual desire not caused by a medical or mental health problem or by a problem in their relationship.

In other words, says Dr. Snyder, it’s for women who love their partners and want to experience more sexual desire, but for some reason have lost their once-healthy libido. According to Addyi’s website, the drug “is believed to work on the part of the brain involved in sexual interest and desire, though its exact mechanism of action is not fully understood.”

Despite its nickname and its common description as the “little pink pill,” Addyi’s makers are quick to point out that it’s not exactly the female Viagra. Viagra works to improve blood flow to the genital area, which can help men get and keep erections. Addyi, on the other hand, targets neurotransmitters in the brain like serotonin and dopamine.

So what’s the controversy?

When Addyi was first introduced, some health experts and activists applauded the pharmaceutical industry’s attempt to address a real problem for many women. Men have medications to treat sexual dysfunction, they argued, and this new drug could, in a sense, level the playing field.

But others argued that there are better ways to treat low sexual desire than with a pill. After all, low libido can be caused by stress, a lack of intimacy, previous sexual trauma, or other underlying emotional problems that medication likely won’t address.

In some cases over the past few years, women were even told by their insurance companies that they needed to see a psychiatrist (and not just a gynecologist or general practitioner) before their prescription for Addyi would be covered.

In addition, experts argue over how well Addyi actually works. In phase 3 trials of more than 11,000 people, a little more than half of the women involved reported some noticeable benefit. Dr. Snyder tells his patients that the drug may help some women who fit the criteria for a prescription, but that others are likely to be non-responders.

Addyi was also rejected twice by the FDA before it was finally approved, and critics argue that even in successful trials, it was only slightly more effective than a placebo. It can also cause side effects like dizziness, sleepiness, and low blood pressure for some women and can interact with some medications.

Finally, women who are prescribed the drug need to take it every single day—not just “as needed” as men do with Viagra. They also must abstain from alcohol, since drinking increases the risk of dangerously low blood pressure.

Those stipulations may be enough to turn some women off of the drug. But Dr. Snyder says that, for others, they’re a small price to pay. “Some women are distressed enough about their lack of desire,” he says. “If a daily medication helps them feel desire again, they’ll feel it’s worth taking it.”

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What’s new with Addyi?

Addyi’s relaunch this week includes a new website and an option for women to consult with a medical professional over the phone and receive their prescription in the mail.

The phone consultation costs $75, and home delivery is available for $25 a month when covered by insurance. (The manufacturer has lowered the price of the drug from $800 to $400.) If someone doesn’t have a health plan that covers Addyi, they’ll pay “no more than $99 a month,” according to the website.

The new, lower price and ease of access may entice more women to try Addyi. But it’s exactly the same drug as it was three years ago, says Dr. Snyder, and patients still need to keep in mind the same safety precautions and lifestyle considerations.

Dr. Snyder’s takeaway? “I do feel that there are some women for whom it’s worth a try,” he says. But it’s unclear how many women will still be interested in the drug after learning about all of its potential risks and benefits, he adds. “That’s something that only becomes clear once it’s widely available and enough people try it.”