Drug Prices Gone Wild: 10 Old Drugs, 10 New Price Tags
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 26, 2021.
Groceries or Medicine? It's Often a Choice
Let's face it -- the costs of many drugs are wildly out of control.
From antibiotics to asthma medications, the pharmacy bill can take your breath away. Even many generics are no longer affordable.
The American public is fed up, according to a Harris poll. Add in stories about patients skipping meals, or cutting their doses in half, and everyone is feeling this price grip.
To better understand these issues, here are 10 drugs with major sticker shock, and the circumstances surrounding their price hike.
Pyrimethamine (brand name: Daraprim)
This drug has made headlines, and pyrimethamine (Daraprim) certainly fits the bill of an old drug.
Originally developed in 1953, Daraprim is used to treat toxoplasmosis, a serious infection especially dangerous in pregnancy and in those with a weak immune system like patients with cancer or AIDS. Pyrimethamine, typically used for malaria, is a folic acid antagonist.
Toxoplasmosis: Cost for 60 tablets of pyrimethamine 25 mg runs over $32,000. Doses may be lowered after 3 weeks, but treatment may last 7 to 8 weeks. In HIV-infected adults, all patients should be continued on chronic maintenance therapy after completion of acute therapy, and while cheaper, is stil lpricey over the long-term.
Daraprim is the only US-approved medication for toxoplasmosis, in combination with sulfadiazine. However, other drugs that may be used include trimethoprim-sulfamethoxazole (Bactrim, Septra), clindamycin and atovaquone (Mepron).
Tiopronin (brand name: Thiola)
Thiola (tiopronin) is another vintage drug from the 1980's. It's used in the rare disease cystinuria to prevent painful kidney stones and reduce the number of procedures to remove them. No generic option is currently on the US market.
It used to cost about $1.50 per 100 milligram (mg) tablet until it was marked it up to about $30 per pill. The problem here: the average dose is 400 to 1200 milligram (mg) per day, which means it takes from 120 to 360 pills -- and $3,700 to $11,000 US dollars -- to treat this chronic, lifelong condition every month.
Related: Thiola Price Guide
Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
Asthma patients can get especially hard hit by high drug prices.
Albuterol, a bronchodilator drug from the 1980's, is the go-to rescue inhaler to treat asthma exacerbations. Kids often need several inhalers -- to carry, to keep at home and at school for emergencies. It's also used in chronic obstructive pulmonary disease (COPD).
Albuterol, as a generic, used to be much more affordable - at about $15 per inhaler. However, as happens with many drugs, new formulations or delivery devices are created that "reset" the patent life, prolonging an affordable option. With albuterol, chlorofluorocarbon (CFC) propellants had to be removed for environmental reasons.
Sure, we're all happy to save the ozone, but this action left asthma patients gasping for breath, often paying over $50 to $90 per inhaler for the cash price. Recently, albuterol brands have become available in generic fashion again, but still run about $30 per inhaler using an online coupon. That still seems like a bargain compared to up to $90 for the brand-name alternative.
Albuterol inhaler: Drugs.com Price Guide and Coupons
Colchicine (Colcrys, Gloperba, Mitigare)
Colchicine is used to prevent or treat acute attacks of gout. Patients typically need 30 to 60 tablets or capsules per month of the 0.6 mg strength for gout prevention.
Colchicine is such an ancient drug -- circa 1950's -- that proper studies were never been done to validate its effectiveness and safety. FDA asked that many of these "grandfathered" drugs be re-evaluated. In 2009, the manufacturer of Colcrys was granted approval and 3 years of marketing exclusivity for this brand of colchicine tablet.
What happened next? Colchicine cash prices soared from less than a dime to almost $5.00 per tablet.
- Today, the cash price a patient might pay with a discounted coupon at the pharmacy for brand name Colcrys runs about $7.00 to $8.00 per tablet depending upon pharmacy, location and coupon discounts.
- The generic tablet for Colcrys, now available, is much cheaper, estmated at about $2 to $4.50 per tablet or capsule for the discounted cash price at the pharmacy, using an online coupon.
- Mitigare, only available in a capsule form, is also roughly $7 per capsule. A generic capsule is also available now and runs about $4.00 per cap.
- Gloperba is an oral solution of colchicone approved in 2019, but no generic is available.
Doxycycline is a widely used antibiotic to treat everything from Lyme disease to sexually transmitted diseases.
- It was originally developed by Pfizer in 1967 under the brand name of Vibramycin.
- A generic has long been available, and it used to be quite affordable.
- However, there was a temporary shortage due to raw materials, and according to one report, the price of the 100-mg dose went up over 6,000 percent (from $.06 per dose to $3.65).
Thankfully, prices have lowered a bit since then, and now run about $1.50 to $2.00 per 100 mg generic capsule, using freely available discount coupons.
See Prices: Generic doxycycline
It's important to check around on pharmacy prices if you pay cash, as your bill could vary considerably. And be sure to ask for the true generic, not a branded-generic, which could run you much more.
Multidrug-resistant tuberculosis (MDR-TB) is a difficult battle. Every year about 90 people are diagnosed with this potentially lethal infection. This form of TB does not respond to, at the very least, isoniazid and rifampicin, the two most powerful anti-TB medicines.
Based on CDC data, direct costs (in 2016 U.S. dollars) average from $18,000 to treat drug-susceptible TB to $513,000 to treat the most drug-resistant form of TB.
Cycloserine (Seromycin) is one of many options used to treat MDR-TB. Originally approved by the FDA in 1964, Seromycin was manufactured by Purdue GMP but a generic option does not exist in the US, according to the FDA.
Cycloserine had been supplied by a nonprofit company known as The Chao Center since 2007. The Chao Center sold cycloserine in August 2015 to Rodelis Therapeutics based out of Ireland. Prices shot up from $16.50 to $360 per capsule. Seromycin now appears to be manufactured by Parsolex Gmp Center, Inc. (the new name for Purdue GMP), but brand prices are not available.
In August 2015, FDA approved Keveyis (dichlorphenamide) to treat a very rare genetic disease known as periodic paralysis that leads to episodes of muscle weakness or paralysis, often in legs and arms.
- Alterations in the potassium levels in the blood lead to the symptoms. Most attacks range from 30 minutes to several hours. This disease affects about 4,000 to 5,000 people in the USm aking this an orphan drug.
- Dichlorphenamide is an old drug discovery; it was originally approved in 1958 as the brand Daranide, an oral carbonic anhydrase inhibitor used to treat glaucoma; now that brand has been discontinued in favor of Keveyis.
Price for Keveyis: Initial doses for paralysis, 50 mg twice a day, appear to be $14,000 or more for 60 tablets, or $237 per tablet. There is no generic option.
Keveyis is distributed through a specialty pharmacy channel as are most high priced orphan drugs for rare conditions. The pharmacists at the specialty pharmacy can help you work with your insurance, the manufacturer's patient assistance program, or can offer other suggestions.
Keveyis is licensed by Strongbridge Biopharma in the US and manufactured by Taro Pharmaceuticals.
Digoxin is a product originally derived from the digitalis plant and is used treat congestive heart failure (CHF) and heart rhythm problems. Although it was a mainstay for many years, today it often replaced with safer and more effective medicines.
- The brand name Lanoxin was approved in 1975, and the generic was the target of a price hike between October 2012 and June 2014.
- The cause of higher prices? Lack of digoxin marketplace competition seemed to be the culprit.
Concerned generic manufacturers pulled out of production after a series of problems with FDA drug safety recalls and manufacturer site inspections. At that time, the prices soared to over 630%.
Drugs.com Price Guide: Digoxin prices
From 2012 to 2014, the generic heart pill went from 11 cents to $1.10 per pill. Currently it seems the price is hovering at around $0.40 to $0.56 per pill for the generic 0.25 mcg strength, but prices can fluctuate. This is another drug where freely available Internet coupons might save you some serious cash at certain pharmacies.
Centruroides scorpion antivenom (Anascorp)
Most scorpion bites in the US are not serious and there is a low risk of death in adults. However, some types of scorpions can lead to severe nerve toxicity, especially in kids. Parts of the Southwest U.S. -- Arizona, New Mexico, and California -- can harbor these creatures.
Intravenous scorpion-specific F(ab')2 equine antivenom (Anascorp) is now recommended for all serious bites. Rare Diseases Therapeutics gained FDA-approval of the initially Mexican-made drug in 2011.
Drugs.com Price Guide: Anascorp Cost
- Ironically, the US drug is still made at the same Mexican company that developed it, but shipped to the U.S., with a higher cost, about $4,400 per vial. Plus you might need 3 to 5 doses of the anti-venom. Hospital bills and administration fees will boost that fee even more.
- If you bought this in Mexico, it would only set you back about $100, according to Kaiser Health News.
Advice? Just be sure to check your boots before you slide them on.
Emflaza (deflazacort), from PTC Therapeutics, is nothing if not controversial.
Deflazacort is a decade's old corticosteroid drug, but FDA-approved brand name Emflaza in February 2017 to treat Duchenne Muscular Dystrophy (DMD). It is used in patients 2 years of age and older, and the drug is dosed based on the weight of the child.
Emflaza is available as a brand name drug only now, and a generic version is no longer available. It comes as oral tablets or as an oral solution. Example prices are:
- $3,804 for a 13 mL bottle of the 22.75 mg/mL
- $6,027 for 30 of the 10 mg oral tablets
- $11,187 for 30 tablets of 36 mg oral tablets
Washington State’s Health Care Authority (HCA) stated another commonly used oral corticosteroid -- prednisone -- cost pennies per tablet and it will be its preferred corticosteroid for DMD patients. The HCA said it was a lower cost, and "equally effective" option. However, prednisone is not specifically FDA-approved for DMD.
Through the PTC Cares program on PTC's website, case managers can help answer questions for patients and provide patient assistance for those who need this drug.
Firdapse (amifampridine or 3,4-DAP), from Catalyst Pharmaceuticals, is an oral treatment used for the treatment of Lambert Eaton Myasthenic Syndrome (LEMS) in adults. LEMS is a very rare autoimmune disorder that affects roughly 1 in one million people.
In LEMS, the body’s own immune system attacks the connection between nerves and muscles, leading to weakness and fatigue. It can be serious and life-threatening if breathing is affected. Patients are often confined to a wheel-chair.
Firdapse was first approved in 2018, but 3,4-DAP had been available through compassionate use long before FDA-approval. The drug was only slightly modified by Catalyst, adding a phosphate salt that stabilized it so it does not need refrigeration.
- Before FDA approval, LEMS patients paid roughly $300 to $500 a month to have the drug compounded at a pharmacy, or could even to get it free from a supplier.
- Patients say the old, unapproved and compounded version of the drug worked good. It's unclear if patients can still use the compounded route to get the drug via compassionate use.
- Dosing for the new Firdapse significantly more. As an example, a one month supply could cost roughly $23,000 (for 120 of the 10 mg oral tablets) if you do not have insurance. Contact the manufacturer for information on patient financial assistance.
In May 2019, the FDA approved Ruzurgi (amifampridine) tablets, the first approval specifically for the treatment of Lambert-Eaton myasthenic syndrome (LEMS) in patients 6 to under 17 years of age.
- Ruzurgi is a potassium-channel blocker and is dosed based on weight. Ruzurgi is considered a competitor to Firdapse, but cash price still hovers around $19,000 for 240 of the 10 mg tablets.
- Most patients will have to use insurance or patient-assistance from the manufacturer, Jacobus Pharmaceutical Co., to access these drugs. No generic option is available.
Finished: Drug Prices Gone Wild: 10 Old Drugs, 10 New Price Tags
Humira, one of the first biologics, is also one of the top selling drugs in the world. But do you know enough about this drug to use it safely?
Society tends to treat menopause as a disease; something to be avoided at all costs. But menopause can be positive. No more monthly mood swings, period accidents, or pregnancy worries. Self-confidence and self-knowledge...
- Houston AR, Beall RF, Attaran A. Upstream solutions for price-gouging on critical generic medicines. J Pharm Policy Pract. 2016;9:15. Published 2016 May 2. doi:10.1186/s40545-016-0064-8
- Lambert-Eaton Myasthenic Syndrome. American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Accessed April 26, 2021 at http://www.aanem.org/Patients/Disorders/Lambert-Eaton-Myasthenic-Syndrome
- Keshavan M. ‘A loss for the rest of us’: An FDA approval is a boon for a drug maker, but could come at a major cost for patients. Stat News. Nov. 30, 2018. Accessed April 26, 2021 at https://www.statnews.com/2018/11/30/fda-approval-lems-drug-costs/
- Emflaza. PTC Cares Helps You Gain Access to Emflaza (deflazacort) 2019. Accessed April 26, 2021 at https://www.emflaza.com/how-to-access-emflaza/
- Gold J. Treating A Scorpion Sting: $ 100 In Mexico Or $ 12,000 In U.S. Kaiser Health News. Accessed April 26, 2021 at khn.org/news/treating-a-scorpion-sting-100-in-mexico-or-12000-in-u-s/
- Tuberculosis — United States, 2016. Morbidity and Mortality Weekly Report (MMWR). March 24, 2017. U.S. Centers for Disease Control and Prevention. Weekly/Vol. 66 / No. 11. Accessed April 26, 2021 at https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6611a2.pdf
- Sagonowsky E. Payer snubs PTC's Emflaza, signaling pricing trouble ahead of launch. April 14, 2017. Accessed April 26, 2021 at http://www.fiercepharma.com/pharma/policy-report-washington-s-largest-healthcare-purchaser-snubs-ptc-s-emflaza
- Mayo Clinic. Tuberculosis. Accessed April 26, 2021 at https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.