Sales Training Guide 2023.pdf

Sales Training Guide Updated August 4, 2023 menMD partners with urologists and men’s health specialists across the country to provide education & treatment resources for men with ED. menMD members have free access to our online education resources, dedicated patient service providers, direct deliv...

Sales Training Guide Updated August 4, 2023 menMD partners with urologists and men’s health specialists across the country to provide education & treatment resources for men with ED. menMD members have free access to our online education resources, dedicated patient service providers, direct delivery, affordable ED medications, and after-hours clinical support. menMD providers benefit from decreased call burden on their offices, robust educational resources for their patients, and increased patient compliance and retention with our combined services and support. 1 A brief history of menMD MenMD was founded by Urologist Ricardo Munarriz, MD, Associate Professor of Urology at the Boston University School of Medicine. Dr. Munarriz specializes in men’s health and the treatment of sexual medicine. He realized that sexual medicine requires a high level of patient interaction from physicians and clinical staff members, that offices are often unable to adequately provide due to increased patient volume and decreased face time at appointments. To provide the doctor’s office and their patients with additional support, menMD was launched in 2010 by our CEO, Carey Frasca, as a clinical hotline to work with patients over the phone after they left their doctor’s office. menMD has now formed lasting partnerships with over 1,200 physicians nationwide to provide these services and more to their patients and practices. The menMD team treats all members with the highest level of discretion and privacy to ensure members have the confidence to ask questions openly and honestly. Members that maintain access to a Member Service Coordinator and our online library of resources experience the best results. menMD now partners with several pharmacy networks across the country to provide a comprehensive repertoire of ED medications at a low cost to patients. We have also begun formulating our own supplements and support products for patients to use in their journey to whole health. In 2022, menMD launched a new Virtual Clinic platform, adding a new layer to our relationships with providers. With the addition of the Virtual Clinic, menMD now refers patients seeking online care directly to urology specialists, mental health care providers, and clinical case managers. Patients can truly rely on our services to provide them with the best possible access to specialists and treatments for their sexual health. Our partnerships with providers set us apart from other platforms and are a key factor in optimizing patients’ health, in the bedroom and beyond. This is our foundation at menMD: to build a community and resource For The Good of Man. 2 Understanding our menMD Providers: What is a urologist? A urologist is a doctor who specializes in diagnosing and treating diseases of the urinary system. This system keeps the body clean by filtering out wastes and toxins and taking them out of the body. The urinary tract includes: ● Bladder. ● Kidneys. ● Ureters. ● Urethra. A urologist also treats conditions involving the reproductive organs and the adrenal glands. The adrenal glands are located on top of the kidneys. The reproductive systems of males and females are linked closely to their urinary systems. You might hear someone use the word “genitourinary.” This refers to symptoms, conditions or treatments that affect both systems. Difference between urology and nephrology If you want to see a doctor who specializes only in the kidneys, you’d make an appointment with a nephrologist. Nephrology is considered a subspecialty, but it’s a subspecialty of internal medicine rather than urology. This means that nephrologists aren’t surgeons. Nephrologists must also be able to manage conditions that happen elsewhere in the body that cause kidney problems or happen because of kidney problems, like high blood pressure. Urologists, on the other hand, are surgeons. How does someone become a urologist? In order to become a urologist, you must first get a bachelor’s degree and then pass the Medical College Admissions Test in order to get into a medical school. It usually takes about four years to earn a medical degree. From there, you spend five to six years in a residency program. During this time you will get training in both surgical and medical treatments of urologic diseases. 3 After that, if you want to specialize in a certain narrower field, you’ll need to complete a fellowship that may last another one to three years. After a residency, you may choose to become board-certified from the American Board of Urology. Then, in order to actually practice as a doctor, you’ll need to take and pass your state medical examination and meet any guidelines that the medical board has issued. What conditions do urologists treat? Urologists treat common conditions and rarer illnesses that affect everyone and some that affect only men or only women. Some of these conditions include: ● Frequent urinary tract infections. ● Inability to control urination (urinary incontinence). ● Blood in the urine (hematuria). ● Conditions of the male reproductive system, including benign prostatic hyperplasia (BPH, or enlarged prostate). ● Interstitial cystitis (painful bladder). Urologists also treat other conditions, such as: ● Cancers of the bladder, kidneys and prostate. ● Erectile dysfunction (ED). ● Kidney stones. ● Pelvic organ prolapse. ● Congenital urinary tract issues (problems with the urinary tract that you are born with). Reasons someone might see a urologist: ● Trouble urinating (peeing), including getting started or having a strong flow of urine, pain, cloudy urine or blood in the urine. ● Changes in urination, like frequent urination or feeling like you always have to go. ● Trouble getting or keeping an erection. ● Infertility. 4 ● A feeling that something is falling down into your vagina or heaviness in that area. ● Pelvic pain. ● Urinating when you don’t want to, like at night or when you sneeze, laugh or exercise. What does a urologist do? A urologist can diagnose and treat many kinds of issues. Some urologists might practice without doing surgery, but all urologists are trained as surgeons. There are subspecialties in urology, including: ● ● ● ● ● ● ● Pediatric urology. Urologic oncology. Kidney transplantation. Sexual medicine. Male infertility. Genitourinary reconstruction. Minimally invasive surgery (robotic, laparoscopic and endoscopic surgery). Pharmacy Partners menMD currently partners with the following pharmacies to provide high-quality, affordable Men’s Health medications to our members: PharmaLabs, St. Petersburg, FL -PDE5s -ICIs -Mitomycin -Testosterone Cypionate -IU Gel -T gel -Supplements -Phenylephrine -Verapamil -Misc. Men’s health drugs & accessories -Estradiol -Mirabegron Wells Pharmacy Network, Ocala, FL -Testosterone pellets 5 Prescriptions are received via: -Fax -menMD Portal -EMR (Electronic Medical Record system) -Phone -Email (bulk orders only) menMD orders are sent to our pharmacy partners via the routes above and are processed according to our partnership agreements to ship directly to the office or patient’s residence. menMD functions similarly to a GPO for offices placing bulk orders, and a health services center for patient members seeking to fill prescriptions with our pharmacy partners. Commercial vs. Compounded Products ● PharmaLabs is a 503A compounding pharmacy that fills patient-specific compounded prescriptions and also carries commercially available prescriptions. ● Wells is a 503B compounding pharmacy that fills bulk orders of sterile prescription products (such as testosterone pellets). ● Retail pharmacies (like CVS/Walgreens) fill commercially available prescriptions and cannot fill compounded prescriptions. ● Patients can only fill our specific compounded prescriptions at Pharmalabs ● Compounded prescriptions are much more affordable than commercially available products. What is the difference between a commercially available & compounded prescription? ❖ Commercial prescriptions​: Prescriptions that you can buy at any retail pharmacy. Product is purchased in a prepackaged container and dispensed to the patient as-is. ➢ Examples: Viagra, Cialis, Edex, Muse, Testim, Androgel, Estrace ❖ Compounded prescriptions: Prescriptions that are produced by compounding pharmacies using the same FDA approved ingredients as commercially available prescriptions, but often in different formulations or strengths to make custom 6 medications not available commercially or to make the medication more cost effective for patients. ➢ Examples: Bimix/Trimix, Tadalafil lozenges, Intraurethral gels, testosterone gel, oxytocin lozenges CONDITIONS AND TREATMENTS CONDITION: ERECTILE DYSFUNCTION Erectile Dysfunction is the persistent inability to achieve and maintain an erection adequate for satisfactory sexual intercourse. INDICATORS OF ERECTILE DYSFUNCTION INCLUDE: ● ● ● ● Inability to get an erection Inability to achieve an erection strong enough for intercourse Inability to maintain an erection during intercourse Any combination of these outcomes CAUSES OF ED: ED is one of the most common sexual health conditions. Over half of men over the age of 40 years report some degree of erectile dysfunction. Erectile function depends on several factors including stimulation (nerves) and blood flow. Conditions that affect a man’s nerves and circulatory system, like diabetes and heart disease can cause ED. Treatment Options: 1. 2. 3. 4. 5. ORAL MEDICATIONS INTRAURETHRAL GELS INJECTIONS (ICI) VACUUM ERECTION DEVICE (VED) PENILE IMPLANTS 7 ORAL MEDICATIONS: PDE5s Inhibitors PRODUCTS: Sildenafil, Vardenafil, Tadalafil PDE5s have an overall success rate of 60% How Dispensed: PHARMALABS USES REGULAR PLASTIC MEDICATION BOTTLES (REFERRED TO AS AMBER VIALS). THEY CAN BE COLORED ORANGE, BLUE, GREEN. Our generic tablets are distributed through an FDA approved U. S. wholesaler. This is a group of 3 pharmacies. The colors and shapes of the tablets will be different depending on which pharmacy they come from, but it is still the same drug. We have no control over what color or shape the patient will receive. ● ● ● ● ● Can only dispense up to a 90 day supply on all tablets. Sildenafil 20 manufacturer is Macleods. Sildenafil 100mg manufacturer: Aurobindo Tadalafil 20mg & 5mg manufacturer.:Accord We compound Tadalafil 5mg & 20mg Lozenges ourselves at Pharmalabs. PDE5s S&H: Shipped Ground (5-7 day delivery) for $10. Patients may choose to pay $25 upcharge for RUSH (Overnight) delivery ($35). S&H - RUSH (M-Thur) $35 S&H - RUSH (Fri for Sat) $40 Product Details: Sildenafil Sildenafil Tablets are a type of PDE-5 Inhibitor (Drug category) that is taken orally to increase blood flow in the Intracavernosal chambers. It is the active ingredient in the commercial drug Revatio(sildenafil 20mg) and Viagra (sildenafil 100mg) Strength: 20mg & 100mg Shelf Life: 1 year + Pricing: $ see price catalog Product Details: Vardenafil Vardenafil can be used to treat erection problems in men (Erectile dysfunction) Strength: 12mg Troche (Lozenges) 8 Shelf life 90 days How to use: The vardenafil troche should be dissolved in the mouth similar to a candy. It may be held under the tongue but that is not a requirement. The mixture of dissolved lozenge and saliva should be swished around the mouth then swallowed. Pricing: $ see price catalog Product Details: Tadalafil Strength: 5MG TADALAFIL ■ ■ ■ ■ Intended for daily/regular use (like a vitamin) regardless of sexual activity Medication needs to be taken properly for at least 10 days to build up baseline level of tadalafil in blood Goal is more spontaneous erections or increased blood flow (penile rehab) Also can be used to treat B.P.H (Benign Prostatic Hyperplasia) or enlarged prostate Strength: 20MG TADALAFIL ■ ■ ■ Intended to produce an erection on demand (but with a longer half life than Viagra) Ideally taken 3 hours prior to sexual activity on an empty stomach for best results. Intended to be taken on an “as needed” basis *Some doctors may prescribe both prescriptions, in which case the patient may use both strengths together, as directed by their physician. The tadalafil lozenges are designed to be dissolved sublingually. The tadalafil generics come in a commercial tablet form. LOZENGES: (SHELF LIFE 90 DAYS) ■ ■ 5MG Lozenge- $ see price catalog 20MG Lozenge- $ see price catalog TABLETS (Generic) (SHELF LIFE 1 YEAR+) ■ 5MG Tablet- $ see price catalog ■ 20MG Tablet - $ see price catalog ■ Cialis vs. Tadalafil ● Our Tadalafil is a generic of Cialis ● We also make compounded lozenges for patients who cannot swallow pills - as of 2023, they are apple flavored 9 ● Tadalafil is used for both daily ED maintenance and for BPH symptom management PDE5s PRICE MATCHING PROMOTION APPLIES TO: ● Sildenafil 20mg Tablets ● Sildenafil 100mg Tablets ● Vardenafil 12mg Lozenges ● Tadalafil 5mg Tablets ● Tadalafil 20mg Tablets *Tadalafil Lozenges are not included in the price match program Product: ICI - Intracavernosal Injections Trimix/Bimix is a self-administered injection to the intracavernosal chambers along the shaft of the penis. ICI has the highest success rate and quickest onset of action of any other medication for erectile dysfunction. Success Rate: 90% How Dispensed: 5mL of solution is dispensed in a 10mL vial. Patients can purchase a minimum of 1 vial and up to the “Max Quantity” as allowed on the prescription. Strength: We carry 16 different mixtures of Bimix and Trimix. The strengths vary based on the amount of each ingredient in the mixture. See product catalog. Pricing: $ see price catalog Shelf Life: 30-60 days Pricing Details: - Quote the patient pricing for (1) 5mL vial at a time - Short expiration Date = don’t oversell the patient unless they request more vials. Shipping: Priority (1-3 day delivery): Vials are stored in the refrigerator so orders are sent on ice in an insulated mailer (‘kangaroo pack’) All vials include a LIMITmarker temperature sensor on the top of the vial. 10 What is ICI? - PGE1 = “monomix” of 1 active ingredient: Alprostadil - Bimix = Mixture of 2 active ingredients: Papaverine & Phentolamine - Trimix= Mixture of 3 active ingredients: Papaverine & Phentolamine & Alprostadil - All of the active ingredients are considered vasodilators which cause blood to flow into the cavernosal chambers in the penis. - Generally, the more ingredients, and the more of each ingredient = the stronger the mixture. o Bimix #4 (30/1) is weaker than Trimix #9 (30/4/40) o Trimix #9 (30/4/40 is weaker than Trimix #16 (30/6/100) ICI Administration: video linked here - Solution is drawn from a 5mL vial using an insulin needle/syringe - Because the injection is performed using an insulin syringe, normally the dose is expressed in terms of insulin “units”. (100 units = 1mL) - Insert the needle into the side of the shaft and depress the plunger to inject the medication - Ideally the injection is performed 15 minutes prior to sexual activity - The erection should last 45-60 minutes - The injection should cause an erection regardless of sexual activity (Unlike PDE-5 medications) - For dosing instructions, refer to the “SIG” field in SFDC o Common Instructions = “Inject 10 units intracavernosally. Increase or decrease by 10 units until desired result is achieved. Max dose 100 units. Do not use more than once every 24 hours.” Shelf life for ICI: - This compounded prescription is potent (meaning it will work) for 60 days after receipt, regardless of whether or not it was opened. 11 - However, each vial is labeled with only a 30 day beyond use date (expiration date) from the pharmacy because it is a sterile drug. o Sterile Drugs: FDA requires anything sterile to have no more than a 30 day shelf life due to the fact that the patient is reusing the vial at home. After 30 days of being “open” or, the vial is at risk for contamination. Edex v. Trimix/Bimix (compound) ● Edex has only 1 primary active ingredient (Alprostadil) ● Bimix has 2 active ingredients (Papaverine & Phentolamine) ● Trimix has 3 active ingredients (Papaverine & Phentolamine & Alprostadil) ● Edex is non-refrigerated and sold by the syringe for single use with 1 year shelf life ● Bimix is non refrigerated and sold by the vial for multi-use with 30 day supply ● Trimix is refrigerated and sold by the vial for multi-use with 30 day supply ● Our Bimix/Trimix (compounds) are more effective and less painful because we have more mixtures to custom fit the patient’s needs. 12 Antidotes for Prolonged Erection (Priapism) Prolonged erections may cause serious irreparable damage to penile tissue. An erection lasting longer than three hours, is a priapism. Patients may experience a prolonged erection when using medications that stimulate blood flow to the Cavernosal chambers. This is especially likely for ICI because it is very strong and self-administered so patients may draw up too much solution. If you ever have a patient on the phone with a priapism, you should immediately refer them to our clinical department or instruct them to go to the emergency room. Some antidotes include Exercise/Shock/Adrenaline - Running up/down stairs - Take a very cold shower to shock the body to stop blood flow - Use an ice pack If exercise and at home remedies do not work: Product: Phenylephrine Phenylephrine causes vasoconstriction, which can assist in the relief of priapism (prolonged erection). We typically sell this directly to providers to use in-office; it is generally considered unsafe to supply this to patients for home use. How Dispensed: 1 mg/mL (strength) diluted vial (total 10mL): $35 How is it administered: An injection to the cavernosal chamber (just like ICI administration) Prescription Only (must be prescribed by the patient’s physician). Cannot be shipped to: CALIFORNIA Shelf Life: 60 days Compounded (Diluted) Phenylephrine is temperature sensitive and does have a temperature indicator sticker on the lid of the plastic bottle it comes in. Ship: Priority 1 -3 days on ice. Compounded (Diluted) Phenylephrine is compounded with these 3 ingredients 1. Phenylephrine HCL powder 13 2. Benzyl alcohol (used as a preservative) 3. Sterile water for injection Product: Pseudoephedrine A 30mg tablet that is swallowed OTC (Over the Counter) may be purchased at any local retail pharmacy (Ex. Sudafed) Refer to physician’s advice, but may help alleviate a very mild priapism Erectile Dysfunction continued Product: Intraurethral Gel Intraurethral Gels are a combination of 1 to 2 ingredients that are inserted into the urethra using a needless syringe (oral syringe) to be absorbed into the cavernosal chambers to increase blood flow. Success Rate: varies based on the indication: ● ● ● For Sexual Activity: 30% For Penile Rehab: 60% For Glans Rigidity (post penile implant): 60% How Dispensed: 1mL oral syringe prefilled with gel. Patients can purchase a minimum of 1 syringe and up to the “Max Quantity” as allowed on the prescription. Strength: We carry 3 different types of intraurethral gel: ● ● ● 2 Drug Gel: PGE1 and Phent Gel (1000/4) - 1mL of Gel 1 Drug Gel: Phent Gel (10mg strength) - 1mL of Gel 1 Drug Gel: Phent Gel (20mg strength) - 1mL of Gel Pricing: $ see price catalog 14 S&H: Shipped Priority (1-3 day delivery) on ice. May not ship ground. Contains ingredient “Alprostadil” which degrades in heat. The temperature indication sticker is on the SIDE OF THE BAG ON THE LABEL, for intraurethral gel. Shelf Life: 45-60 days. (It can have a shelf life anywhere in that day range because of the day it is batched. Common Side Effects : Discomfort and burning sensation. Below is a comparison of our compounded Intraurethral Gel and the commonly known commercial product, Muse. Muse vs. Intraurethral Gel (compound) ● Muse has only 1 primary active ingredient (Alprostadil) ● Our Intraurethral Gel (compound) has either 1 active ingredient (Phentolamine) or 2 active ingredients (Phentolamine & Alprostadil) based on the formulation ● Muse is in a pellet form that dissolves in the urethra ● Our Intraurethral Gel (compound) is a gel that is inserted down the urethra via an oral syringe. ● Our intraurethral gel (compound) is less painful/less burning because you can take smaller doses of Alprostadil 15 BOSTON SCIENTIFIC PRODUCT: PENILE IMPLANT (IPP) Surgically implanted Inflatable Penile Prosthesis (IPP) or bendable rod establishes erection on demand erections last as long as desired, high patient satisfaction surgical pain or infection can occur, typically during the healing process. The AMS 700 is an inflatable implant consisting of two inflatable cylinders within the penis and a small pump placed in the scrotum in between the testicles. After implantation, the man’s penis looks natural whether inflated or flaccid. Inflation takes less than a minute. Penile implants are highly effective and the best solution for patients with severe ED who are unsatisfied with non-surgical treatment options, such as, oral medication, intraurethral gel, and injection therapies. See video link here. CONDITION: PEYRONIE’S DISEASE Peyronie's disease is a disorder in which scar tissue, called plaque, forms under the skin of the penis—the male organ used for urination and sex. The plaque builds up inside the penis, in the thick elastic membrane called the tunica albuginea. The tunica albuginea helps keep the penis stiff during an erection. PEYRONIE’S TREATMENTS: ● Verapamil Injections ● Verapamil Cream ● Pentoxifylline Product: Verapamil Injection Verapamil is used to combat symptoms of pain and curvature of the penis due to Peyronie’s disease. We sell both a cream and an injection. The medication is injected into the plaque to slow curvature and allow patients to have intercourse. How Dispensed: 4mL’s of medication in a 5mL vial Strength: 2.5mg/mL Pricing: $ see price catalog S&H: Fedex Priority 1-3 Mailing days 16 Shelf Life: 60 Days Shipping: Vials are stored in the refrigerator so orders are sent on ice in bubble wrap then in a box. CANNOT SHIP TO CALIFORNIA Verapamil Injection Administration: Verapamil will only be administered in the doctor’s office. Injected directly into the lesion on the penis Common Instructions = “inject four doses of 1mL per treatment, directly into the lesion. Repeat treatment every 2 weeks.” Prescription dispensing: Vial(s) of Medication: contains 4mL per vial purchased. Syringe kit (s) are needed for the amount of treatments. Product: Verapamil Cream Verapamil Cream is used in combination with the injection and is a calcium channel blocker. How Dispensed: In a 50mL pump jar (similar to germX) with 30mL of medication Strength: 12% Cream Pricing: $ see price catalog S&H: USPS ground 5-7 mailing days Shelf Life: 60 days Shipping: Cream is stored at room temperature so orders are sent in a box ground delivery unless the patient wants to pay the upcharge to Priority (1-2 day delivery). Prescription dispensing: Standard Issued Pump Jar: with the quantity of mLs they purchased inside. If the patient purchases more than 30mLs, he may receive 2 pump jars (with approximately 30 within each). Product: Pentoxifylline Pentoxifylline tablets are used to increase blood flow and increase nutrients to the damaged areas. This is not regarded as a stand-alone treatment for peyronie’s disease, as it should be used in combination with injection therapy. The desired effect is pain and curvature resolution. 17 How Dispensed: In tablets in a pill bottle. Patients can purchase a minimum of 1 tablet and up to the “Max Quantity” as allowed on the prescription. Strength: 400mg tablet Pricing: $ see price catalog S&H: Ground USPS (5 - 7 days) Shelf Life: 1 year + Administration: Patients swallow the tablets orally. It may take up to 2 two full months to obtain full benefits. Common Instructions = “Take 1 tablet by mouth 2-3 times daily.” Prescription dispensing: Standard Issued Pill Jar: with the quantity of tablets they purchased inside. CONDITION: HORMONE REPLACEMENT HORMONE REPLACEMENT TREATMENTS: ● ● ● ● ● ● ● Testosterone Injections Testosterone Gel Testosterone Pellets Testosterone Rapid Dissolve Tablets Clomid Capsules Sermorelin Anastrozole PRODUCT: TESTOSTERONE CYPIONATE Strength: 200mg/mL solution dispensed in a 1mL vial Accessories: (1) syringe kit per injection. We defer to whatever size has been indicated by the provider. If the provider has not chosen a size, we default to the 23Gx1.5 inch syringe kits (18G Draw needle, 23G inject needle, syringe barrel). Patients also have the option to choose a 18 different size of their preference, provided they are not located in Washington D.C., NY, MO or NH. Price: ● $13/ mL of medication ● Syringe Kit- $1/ea (members typically require one kit per injection) Filling a Testosterone Cypionate order: The pharmacy processing team will enter the member’s dose, use frequency, quantity, and *syringe type. This information can be found in the SIG, and under the ‘Testosterone’ section of the rx page *Some members may prefer a size different from what was recommended by their physician. Provided they are not located in Washington D.C. NY or NH,MO members are welcome to order whatever size they prefer -In addition to the standard demographic information (First and last name, DOB, medication allergies, address) we need to obtain the member’s Driver’s License number, and ask whether they have a specific allergy to sesame or sesame oil. NOTE: If the member reports an allergy to sesame or to sesame oil, that is a HARD STOP. The member will have to consult their provider about filling their medication at a retail pharmacy for Depo-testosterone. (Not made with sesame oil) Commercial Comparison: 19 Depo Testosterone vs. Testosterone Cypionate (compound) ● ● ● ● ● ● Same strength - both are 200mg/mL Depo is mixed with cottonseed oil (thicker) Our testosterone cypionate (compound) is mixed with sesame oil Depo is sold in 1cc and 10cc vials for multi-dosing Our testosterone cypionate compound is sold in 1mL, 2mL, and 3mL vials for multi-dosing Our compounded testosterone cypionate is in a thinner carrier oil, so injections are less painful PRODUCT: TESTOSTERONE GEL How Dispensed: in an UNO DOSE device. It is similar to a gel deodorant stick. When you rotate the dial on the bottom clockwise you will hear a 'click', each click is .25ML. This is how dosing is measured. Each UNO DOSE device will contain a maximum or 30ML. It is usually applied to the thigh or shoulder. Strength: 50mg/mL (5%) & 200mg/mL (20%) Pricing: $ see price catalog S&H: USPS ground 5-7 mailing days Controlled Substance: YES, patients can only fill up to a 60 day quantity Commercial Comparison: AndroGel vs. Testosterone Gel (compound) ● Androgel is sold in a pump jar and gives 20.25mg per pump ● Our compounded testosterone gel is sold in a topi-click jar and gives 12.5mg per “click” ● Androgel is 24mg/mL of gel ● Our testosterone gel is 50mg/mL of gel ● Our compounded testosterone gel is more concentrated, so less gel is needed to obtain the same dose of medication PRODUCT: TESTOSTERONE PELLETS Pellets are a unique way to treat hormone imbalances into the body. Testosterone pellets are compounded hormones made from organic plant materials, which have the same molecular structure of those hormones found in the body. In a simple, quick in-office procedure, your 20 doctor inserts a prescribed number of rice-grain-sized bioidentical hormone pellets under the skin near the hip. These pellets will release steady small amounts of hormone(s) directly into your bloodstream for an average of several months. Consistency — Pellets supply a consistent level of hormones released in the bloodstream ● Closest to nature — Pellets mimic your body’s natural delivery system more closely than any other method. ● Convenience — You don’t need to worry about remembering to take your medication daily. Hormone pellets only need to be inserted 2-4 times per year depending on what your physician prescribes and what works best for your body. ● Fewer side effects — Pellet therapy bypasses the liver, sending hormones directly into the bloodstream, and avoiding certain side effects of oral medications. Pellet and Trocar Ordering Options ● Testosterone Pellet - 87.5mg (3mm pellet) $20 Retail ($17 to Office) ● Testosterone Pellet - 100mg (3mmg pellet) $22 Retail ($19 to Office) ● Testosterone Pellet - 200mg (4.5mm pellet) $34 Retail ($29 to Office) ● Testosterone/Anastrozole Pellet - 100mg/4mg (3mm pellet) $30 Retail ($26 to Office) ● TROCARS: (all Disposable) ● 3.2mm Plastic Tip (cannot be used with the 200mg pellet) $27 ● 3.2mm Stainless Steel Tip (cannot be used with the 200mg pellet) $32 ● 4.5mm Stainless Steel Tip (200mg pellet only) $32 S&H: All Orders are Shipped 2 Day Air: - Wells 2 Day $25 Pellets can ship to all states EXCEPT: * AL, AK, CA, IN, MI, MN, NH, NY, ND, OK, WY ● MUST SHIP TO MD OFFICE ● WE CANNOT REQUEST REFILLS FOR PELLETS PT MUST BE CALLED AND NOTIFIED TO SEE MD FOR REFILLS. Pellet Insertion video linked here PRODUCT: TESTOSTERONE RDT Product Name: Testosterone Rapid Dissolve Tablet Strengths: 5mg and 50mg Price: $ see price catalog Vial: Orange or Blue Pill Bottle Dosage Form: Breakable Rapid Dissolve Tablet What is it? 21 Our Testosterone in rapid dissolve tablets offers a convenient solution by combining a common Low-T treatment in an easy-to-take, daily dose. Once placed between the cheek and gum or on the tongue, this rapid dissolve tablet dissolves and releases testosterone directly into the bloodstream through the oral mucosa. This bypasses the liver and gastrointestinal system, providing a more consistent and steady release of testosterone. As a result, it effectively addresses symptoms related to low testosterone levels and improves overall well-being. Testosterone is metabolized extensively when given orally therefore reducing the amount that actually has a clinical effect, but with RDT formulation it's absorbed transmucosally which allows it to bypass metabolism. With our Rapid Dissolve Tablet formula, you can adjust the dosing by breaking the tablet in half or quarters. This allows you and your provider more options to get a custom strength that fits you best. What is the dosing of this? The blood levels and clinical effect are going to vary for each person so understanding that our RDT dosing is adjustable to find what works best for each patient is important. It's difficult to broadly categorize specific dosing on the RDTs since everyone is different, but generally the 50mg 1/2 twice per day or 1 twice per day is a good starting point and then check blood levels as directed by the provider. Directions: Take once or twice a day as prescribed Shelf Life: 180 days Storage: Storage at PLabs: Room Temperature Storage Conditions For Patient: Room Temperature Shipping: Standard Ground Shipping (5-7 business days) How is it sold? Per tablet. Max Qty/Fill= 180 Product: CLOMIPHENE CITRATE Taking clomiphene encourages your brain to release two hormones: LH (luteinizing hormone) and FSH (follicle-stimulating hormone). These hormones tell the testicles when to ramp up testosterone production (Mbi Feh, 2022). Because Clomid doesn't dull testosterone production like TRT, it maintains male fertility. In women, it stimulates the same hormones, which help initiate ovulation Both uses assist with fertility treatments. 22 Strengths: 25mg and 50mg capsules Price: $ see price catalog for pricing Product: SERMORELIN Strengths: 200mcg and 400mcg Price: $ see price catalog for pricing Vial: Orange or Blue Pill Bottle Dosage Form: Lozenge (Troche) What is it? Sermorelin is a synthetic version of growth hormone-releasing hormone (GHRH), a naturally occurring hormone that stimulates the pituitary gland to produce HGH. When ingested, sermorelin mimics the effects of GHRH, triggering the pituitary gland to release more HGH into the bloodstream, increasing the bioavailability of the hormone. Sermorelin can help Increase growth hormone and insulin-like growth factor-1 (IGF-1); General well being, anti aging, energy levels Is this a controlled substance? No Directions: Dissolve 1 lozenge daily Shelf Life: 90 Days Storage: Fridge ● Storage at PLabs: Fridge ● Storage Conditions For Patient: Fridge Shipping: On Ice (Overnight only for summer) How is it sold? Per lozenge Max Qty/Fill= 180 Product: Anastrozole Anastrozole lowers the levels of estrogen hormones in the body Can be used for men & women -1mg tablets CONDITION: Bladder Irrigation Product: Mitomycin Mitomycin is a chemotherapy drug to treat bladder cancer that is instilled into the bladder via 23 insertion of a urethral catheter. Mitomycin does not need to be refrigerated. How Mitomycin is dispensed: As a 8mL solution in a clear sterile vial filled to 9mL to allow for 8mL to be withdrawn. Physicians may purchase anywhere from 1-8 doses per patient name. Accessories: (1) Mitomycin Kit: Kit Includes (1) 50mL vial of sterile water, (1) Pair Chemo Rated Gloves, (1) syringe, (1) 18G needle for $10 Strength: 40mg Pricing: $125/vial Shelf Life: 60-180 days Product: DMSO/Lidocaine DMSO is a treatment for interstitial cystitis. It is instilled into the bladder using a catheter to reduce bladder irritation and pain (anti - inflammatory). To help relax the bladder and pelvic muscles (antispasmodic). It helps relieve pain by depleting the level of substance P levels from bladder nerves increasing bladder capacity by breaking down the scar tissue by preventing the formation of collagen. How it’s dispensed: Our DMSO/Lidocaine 50%/0.5% comes in 50 ml vials normally supplied directly to the providers office. The provider then administers treatment directly to patients. CONDITION: BPH Product: Finasteride Works by stopping testosterone (a sex hormone) turning into another hormone called dihydrotestosterone (DHT). DHT can cause your prostate to grow bigger. It can also stop your 24 hair growing. Finasteride stops DHT being produced and this helps shrink your prostate and reduce hair loss. -1mg tablets for hair loss -5mg tablets for BPH Product: Tamsulosin Tamsulosin belongs to a group of medicines called alpha-blockers. It's used to treat men with symptoms of an enlarged prostate (benign prostate enlargement) -0.4mg capsule -$27 for QTY 30 Product: Tamsulosin + Tadalafil 0.4mg/5mg Product: Finasteride + Tadalafil 5mg/10mg Tadalafil CONDITION: ANORGASMIA Product: Oxytocin Oxytocin is the hormone that surges in the body and causes ejaculation in men. Most oxytocin products on the market are sold as nasal spray. It can be used during intercourse to stimulate an orgasm for both men and women. Oxytocin should be taken within 10 minutes of anticipated climax. -50iu strength is the standard urological dose -Sold in 200iu strength, breakable tablet CONDITION: OVERACTIVE BLADDER Product: Mirabegron Mirabegron treats overactive bladder and relieves symptoms for patients experiencing frequent urges to urinate. -20mg capsules: $69/QTY 30 -40mg capsules: $79.59/QTY 30 CONDITION: HERPES Product: Valacyclovir Valacyclovir is an antiviral used to treat herpes virus. -500mg tablets: $0.75 ea 25 -1000mg tablets: $1 ea CONDITION: COUPLES CARE Product: Estradiol THERE ARE 2 KINDS - TOPICAL THAT IS APPLIED EXTERNALLY AND VAGINAL THAT IS INSERTED. BOTH KINDS Min Quantity/Order: 30mL Max Quantity/Order: 180 days supply Shelf Life:180 days Estrace vaginal cream vs. Estradiol Cream (compound) ● Estrace sold in a 42.5g tube at 0.01% strength, which usually costs around $130 ● Our Estradiol vaginal cream is sold in a 30g pump dispenser at 0.0125% (comparable strength) ● We also carry an Estradiol+DHEA mix (DHEA helps increase the uptake of estradiol in the body) ● Our estradiol is in a basic cream base with no known allergens ● We also sell a stronger topical cream (0.15%) Comparison of menMD Products to commercially available products: Commercial Dosage Form Price Product Edex/ Prefilled Syringe Caverject for single use $85/syringe menMD Dosage Price Product Form Bimix/Trimix Vial of $85-$125 for (Compound) Solution for 30 day multi-dose supply usage 26 Muse Pellet for single $75/pellet use Viagra Cialis Intraurethral 1mL syringe $5-$25 per Gel of gel for use (Compound) multi-use 50mg & 100mg $6 for 50mg Sildenafil 20mg & tablet & 100mg *price matched 100mg tablet $1.00 5mg & 20mg tablet $375 for (30) Tadalafil 5mg & 20mg 5mg tab/loz: 5mg & $70 *price matched tablet & $1.00/$1.30 lozenge 20mg for 20mg $0.75/ tab/loz: $2.50/$7.50 Depo 200mg 1cc & 10cc $30 for 1cc Testosterone 200mg 1cc & $13 for 1cc Testosterone vial for multi-dose vial & $100 Cypionate 3cc vial vial & $39 usage for 10cc vial (Compound) 20.25mg/Pump $130 for 2 Testosterone pumps = Gel 40.5mg (Compound) Andro-Gel Xiaflex for 3cc vial 50mg/mL $1.30 for 1mL = 50mg Verapamil 27 Salesforce Terms to know: MD Status: New = never referred us a patient Not Active = has referred us a patient but the most recent referral was >1 Year ago Active = has referred us a patient and the most recent referral is within the past year. Provider Group: A1 = provider that sends us 20 or more referrals/year & is Active within the last year A2 = provider that sends us 20 or more referrals/year & is NOW Expired or Not Active B1 = provider that sends us 10-<20 referrals/year & is Active within the last year B2 = provider that sends us 10-<20 referrals/year & is NOW Expired or Not Active C1 = provider that sends us 4-<10 referrals/year & is Active within the last year C2 = provider that sends us 4-<10 referrals/year & is NOW Expired D1 = provider that sends us 0< to <4 referrals/year & is Active within the last year D2 = provider that sends us 0< to <4 referrals/year & is NOW Expired 28