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Table 1.  
Comparison of the Mean Copayment and Price per Gram From January 1, 2008, Through December 31, 2013, for Topical Corticosteroids
Comparison of the Mean Copayment and Price per Gram From January 1, 2008, Through December 31, 2013, for Topical Corticosteroids
Table 2.  
Comparison of the Mean Average Wholesale Price and Price per Gram From January 1, 2008, Through December 31, 2013, for Topical Corticosteroids
Comparison of the Mean Average Wholesale Price and Price per Gram From January 1, 2008, Through December 31, 2013, for Topical Corticosteroids
1.
Copeland  R, Black  K, Pachter  L, Svoboda  R. Drug pricing: research on savings from generic drug use. January 31, 2012. http://www.gao.gov/assets/590/588064.pdf. Accessed May 2, 2015.
2.
Alpern  JD, Stauffer  WM, Kesselheim  AS.  High-cost generic drugs—implications for patients and policymakers. N Engl J Med. 2014;371(20):1859-1862.
PubMedArticle
3.
Office of the Inspector General, Department of Health and Human Services. Medicaid drug price comparison: average sales price to average wholesale price.https://oig.hhs.gov/oei/reports/oei-03-05-00200.pdf. Accessed March 7, 2015.
4.
Bureau of Labor Statistics, US Department of Labor. Consumer Price Index. Updated May 2015. http://www.bls.gov/cpi/. Accessed March 3, 2015.
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Research Letter
November 2015

Variation in the Cost of Generic Topical Corticosteroids

Author Affiliations
  • 1Penn State Hershey College of Medicine, Hershey, Pennsylvania
  • 2Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Dermatol. 2015;151(11):1255-1256. doi:10.1001/jamadermatol.2015.2394

Prescription medications accounted for $307 billion in the United States in 2010, or about 12% of all US health care spending. Prescribing generic rather than brand-name medications, including topical medications, has been encouraged as a way to curb spending on prescription medications. In fact, the growth of spending on prescription medication has decreased in association with increased use of generic drugs.1 However, practitioners and patients can be frustrated by the affordability of even older generic medications.2 This paradoxical situation came to light with the shortage, and subsequent increased cost, of doxycycline hydrochloride in 2013. Recently, we had many patients experience a high cost for topical clobetasol propionate; we undertook this study to investigate the variation in costs of generic topical corticosteroids of various potencies.

Methods

We investigated the unit cost for topical corticosteroids of multiple potencies and unit size by retrospectively analyzing the Truven Health MarketScan Commercial Claims and Encounters Database, which contains health insurance claims paid by approximately 100 payers for more than 120 million individuals in the United States. Paid prescription claims for topical corticosteroids during the study period (January 1, 2008, through December 31, 2013) were identified. The copayment and average wholesale price (AWP) were extracted. The copayment reflects the patient’s out-of-pocket cost; and though the AWP is a frequently cited conventional variable, it is less practical because it is often higher than the price paid by the pharmacy or patient.3 Descriptive statistics were performed using SAS, version 9.3 (SAS Institute). Prices were adjusted for inflation and are reported in 2013 US dollars.4 The Penn State Institutional Review Board exempted this study from review. Analysis was performed March 5 to June 2, 2015.

Results

The cost of topical corticosteroids varied across potencies, class (potency), and by branded generic or generic product. Claims for branded generic products were less frequent and had a higher copayment and AWP. Table 1 shows the mean copayment for topical corticosteroids. There are noteworthy differences among generic topical corticosteroids in the same class; for example, the mean cost of triamcinolone acetonide, 0.01%, was 30% to 40% lower than other mid-potency medications when dispensed as a 15-g or 30-g tube. There were also important differences in the cost per gram for different size tubes of the same medication (Table 1), such as triamcinolone acetonide, 0.01%, which was $0.24 per gram as a 15-g tube vs $0.02 per gram when dispensed in a 454-g jar. Also, branded generic products had copayments approximately 3 to 5 times higher than a generic product with the same ingredient and unit size.

As expected, the mean AWP was higher than the mean copayment for all corticosteroids and sizes (Table 2). Again, there were cost differences among topical corticosteroids by potency or unit size. For instance, 1 pound of triamcinolone acetonide, 0.01% ($40.73 for a 454-g jar), and betamethasone valerate, 0.1% ($324.40 for ten 45-g tubes), have nearly a 10-fold difference in cost despite similar potency. Also, fluocinonide acetonide, 0.05%, was approximately half the cost of the similarly potent clobetasol propionate, 0.05%, cream ($23.20 vs $42.07 per 30 g).

Discussion

Successfully managing dermatologic conditions requires health care professionals to not only develop a diagnosis and treatment plan but also consider the patient’s financial burden. The mean retail price of a generic drug is 75% lower than its brand-name equivalent, and increasing generic drug use saved approximately $1 trillion in health care costs from 1999 through 2010.3 However, generic medications are not similarly priced, as this investigation shows. Furthermore, the mean AWP and copayment for generic topical corticosteroids are not proportional to potency and larger units are more cost effective. There are opportunities to reduce costs by prescribing larger units rather than repeatedly refilling smaller tubes. The limitations of this investigation include difficulty generalizing the findings to specific situations, lack of patient outcomes, and not controlling for differences in drug vehicles. Health care professionals may preserve high-quality patient care while reducing cost for the patient by being aware of the differences in generic medications.

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Article Information

Accepted for Publication: June 15, 2015.

Corresponding Author: Joslyn S. Kirby, MD, MS, Department of Dermatology, Penn State Milton S. Hershey Medical Center, 500 University Ave, Mailcode HU 14, Hershey, PA 17033 (jkirby1@hmc.psu.edu).

Published Online: August 19, 2015. doi:10.1001/jamadermatol.2015.2394.

Author Contributions: Dr Foulke and Mr Skojec had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Foulke, Kirby.

Statistical analysis: Skojec.

Administrative, technical, or material support: Foulke, Kirby.

Study supervision: Foulke, Kirby.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Douglas Leslie, PhD, Department of Public Health Sciences, Penn State, assisted with the statistical analysis. He was not compensated for his contribution.

References
1.
Copeland  R, Black  K, Pachter  L, Svoboda  R. Drug pricing: research on savings from generic drug use. January 31, 2012. http://www.gao.gov/assets/590/588064.pdf. Accessed May 2, 2015.
2.
Alpern  JD, Stauffer  WM, Kesselheim  AS.  High-cost generic drugs—implications for patients and policymakers. N Engl J Med. 2014;371(20):1859-1862.
PubMedArticle
3.
Office of the Inspector General, Department of Health and Human Services. Medicaid drug price comparison: average sales price to average wholesale price.https://oig.hhs.gov/oei/reports/oei-03-05-00200.pdf. Accessed March 7, 2015.
4.
Bureau of Labor Statistics, US Department of Labor. Consumer Price Index. Updated May 2015. http://www.bls.gov/cpi/. Accessed March 3, 2015.
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