Long Island Dermatological Society

Generic Drug Prices Climb

December 12, 2013
 


Marked Increase in Generic Drug Pricing

April 2015 Update

October 2014 Update


December 12, 2013

Did you know that over the past year the price to the pharmacist for a 60 gm tube of generic desonide cream rose from $26.75 to $248.04?  Or that the cost for a month of generic doxycycline 100mg tablets taken twice daily jumped from $3.40 to $222.68?

 We practice in a healthcare system whose runaway costs are hurting our patients, and are inducing ever increasing intervention in our practices by government and insurance companies.  We all know that the costs of name brand drugs have been rising.  However, recently there have been significant, often dramatic increases in the price of generic medications, including certain topical dermatologics.  

We would like to make you aware of this trend, and to provide current pricing information.  This will allow you to accommodate the financial needs of patients with limited insurance coverage, and to maximize value for the healthcare system.  This information was obtained  from a federally sponsored nationwide survey of prices paid by retail community pharmacies available at the medicaid.gov website.  We are including cost information for topical dermatologics which have been sorted by name, by package cost, and by price increase.

Also available for download is a spreadsheet containing current pricing for all medications sorted alphabetically.   Finally there is a version dividing entries into generics, name brands and OTCs, each sorted by price increase, to detect medications whose price is rising rapidly.  Some of these increases are astounding.  
 

We hope to update this data periodically, so check with us again.

Skin Topicals Sorted by Price Increase

Skin Topicals Sorted by Package Price

Skin Topicals Sorted Alphabetically 

 

Full Database Sorted Alphabetically

Database Sorted by Price Increase 10/4/12-10/3/13

 (This file replaces and includes Drugs Which Doubled in Price Sorted by Price Increase)

October 1014 Update


The most dramatic change over the past year was the 179-fold price increase in generic tetracycline, increasing the monthly cost of 500mg BID dosing from $2.89 to a whopping $518.  This was reportedly due to a drug shortage, although the shortage had resolved in March according to the FDA website.  Other oral medications with dramatic increases included up to 60-fold increases in captopril, 26-fold rises in amitryptyline, and an almost 18-fold increase in carbamazepine.

The most striking change in the past year from the point of view of dermatology has been the increase in the price of topical clobetasol.  There has been an jump in pharmacy cost for some formulations of close to 20-fold.  A 60 gm tube of  clobetasol ointment which cost $17 a year ago is now $300. The cost of generic tretinoin has increased as much as 6-fold, with a 45 gm tube of 0.025% cream going from $25 to $150 in the past year.  Westcort generic also had a generous increase going from $27 to $110 for a 45 gm tube. 

The cost of generic topicals which have increased in cost at least four-fold in the past 2 years also includes generic formuations of topical steroids Desowen, Lidex  Ultravate, Locoid, and Dermasmoothe, along with generic hydroquinone, clindamycin solution, and ciclopirox solution.

Below are links to download the full alphabetic database for 10/1/14, as well as sorts for price increases over the past year, and over the past 2 years:

Full Database Sorted Alphabetically 10/1/14

Database Sorted by Price Increase 10/3/13-10/1/14

Database Sorted by Price Increase 10/4/12-10/1/14

The following are links to updated files containing prices for topical dermatologicals sorted according to degree of price increase from October 2013-2014, total package price, and an alphabetical listing: 

Skin Topicals Sorted by Price Increase 10/3/13-10/1/14

Skin Topicals Sorted by Package Price 10/1/14

Skin Topicals Sorted Alphabetically 10/1/14

 APRIL 2015 UPDATE

In the race for the most rapidly rising of all generics over the past 6 month the winner is … hydroxychloroquine.  The pharmacy cost for the 200 mg tablet rose 16.7-fold, from $5.91 to $98.67 for a one month supply of BID dosing, reportedly due to a drug shortage.   Coming in second is another dermatologic, topical econazole, with an increase of as much as 11-fold. The pharmacy cost for a thirty gm tube of econazole rose over the past 6 months from $14.52 to $160.90.  Should you wish to save money for your patients, please be aware that fungicidal topical terbinafine is 1/20th the cost, and requires only a week of application for effectiveness.

While this site usually focuses on generics, there are a couple name brand topicals whose price has increased more than any others over the past 6 months.   They are Carac and Vanos, whose pharmacy cost increased by 50%.  While this percentage increase is not as high as for many generics, it is notable because the price of these medications was extremely high to begin with.  With the increase, the cost to the pharmacist of a 30gm tube of Carac is now $2428.97, and the cost of a 120gm tube of Vanos is $3034.44, making them staggeringly expensive topicals.  While it may be true that the cost to patients after rebates or copay reductions may be minimal, the cost to the healthcare system is significant.  And ultimately these costs can be passed back to patients in the form of increased copays and deductibles. 

By downloading the files on this website you can get valuable information on drug pricing.  And while it is always important to prescribe the medications you feel are best for your patients, in situations where there are a number of  treatments of similar effectiveness, considering cost can allow you to help your patients while minimizing financial harm.  That's a course Hippocrates might follow. 

Below is a link to download the full database for 4/1/15 sorted according to greatest relative price increase since 10/1/14 to show those drugs having the greatest percentage increase over the past 6 months, as well as a link to an alphabetical list for more convenient lookup. 

Full Database Sorted Alphabetically 4/1/15

Database Sorted by Price Increase 10/1/14-4/1/15

Here is a link to a file containing updated prices for topical dermatologicals sorted according to total package price.  Name brand topicals are listed first, then generics.  If you are interested in scanning a list of inexpensive generics (get em while you still can) just scroll to the bottom of the spreadsheet.  An alphabetical file is also available for your convenience.

Skin Topicals Sorted by Package Price 4/1/15

Skin Topicals Sorted Alphabetically 4/1/15

Note: Before using this information for critical decisions we recommend you confirm it from the source data from the Survey of Retail Prices on the Medicaid.gov website. 

Methodology for Calculation of Comparative Pricing on Spreadsheets:

The data for these spreadsheets was obtained from the Survey of Retail Prices, a weekly survey of drug acquisition costs for retail community pharmacies on the Medicaid.gov website.  Before using this information for medical decisions we recommend you confirm it from the source data.  This can be referenced by downloading  NADAC Files from the website at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Survey-of-Retail-Prices.html.  Click on the PHARMACY DRUG PRICING PAGE link for current year prices, and on ARCHIVED NADAC FILES for historical prices.

For comparison of 2 spreadsheets, corresponding historical data was added to the  NDC, NADAC  price per unit, and (Effective) Date columns of the current spreadsheet.  This combined database was then sorted, primarily by NDC number, and secondarily by survey date (in descending order). In case of formatting differences between spreadsheets, entries appearing to be numbers were sorted as numbers.

A comparison column was created to indicate which items on the current spreadsheet were also on the historical spreadsheet.  The value in this column was set to equal to the difference between the NDC number in the current row (a unique identifying number for an individual formulation and manufacturer) and the matching NDC number from adjacent row.  Copying this formula to the rest of the column produced zeros in all rows for which historical data existed.

A ratio column was created. The value in this column was set equal to the quotient of the NADAC  (average price per unit) for the medication in the current row with that of an adjacent historical row containing the matching NDC number.  This formula was copied into all rows of the ratio column.  For rows having zero in the comparison column, the values in this column corresponded to the ratio of the current price and the historical price.

The values of formulas were then fixed (by copying, then pasting values only) to prevent them from changing when the rows were sorted.  The database was then sorted according to the value in the comparison column.  All rows having non-zero values in this column were deleted, as they lacked corresponding historical data.  

The resulting database was then sorted alphabetically according to NDC description.  It was also sorted to according to price increase within categories of generic, brand and OTC, using OTC (ascending) as primary sort, Classification for Rate Setting (descending) as secondary sort, and the Ratio column (descending) as the tertiary sort. 

A similar protocol was used to combine 3  spreadsheets, in which price ratios of 1 year and 2 year comparisons were calculated and transferred  to rows containing current data using NDC number identity to guide placement of ratios into appropriate rows.





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