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Wehner MR, Nead KT, Lipoff JB. Association Between Gender and Drug Cost for Over-the-Counter Minoxidil. JAMA Dermatol. 2017;153(8):825–826. doi:10.1001/jamadermatol.2017.1394
Minoxidil is a US Food and Drug Administration (FDA)–approved over-the-counter topical medication for androgenetic alopecia marketed and sold to men and women. Approximately 50 million men and 30 million women in the United States have androgenetic alopecia,1 and hair loss treatments represent a global market valued at $7.2 billion in 2015.2 Minoxidil is available as a 5% solution to be applied twice daily for men, 2% solution applied twice daily for women, and 5% foam applied twice daily for men (FDA approved in 2006) and once daily for women (FDA approved in 2014). Gender-based price differences have been well documented in consumer products: one 2015 report found that women’s personal products were 13% more expensive than equivalent men’s products.3 However, to our knowledge, gender-based price differences for medications have not been previously studied. We aimed to investigate price differences by gender for minoxidil products.
We collected data on minoxidil products from July 22 to November 28, 2016, at 6 of the largest national-chain pharmacies (CVS, Kroger, Rite Aid, Target, Walgreens, and Walmart4) in 4 states (Pennsylvania, New York, Ohio, and Indiana). For each product, we collected retailer, brand, vehicle, price (original, excluding sales price), percentage of minoxidil, volume, application directions, gender specification, and inactive ingredients. This study was institutional review board exempt.
Prices per 30 mL were compared for (1) women’s (minoxidil, 2%) and men’s (minoxidil, 5%) solution and (2) women’s and men’s (both minoxidil, 5%) foam. Products were matched by brand, retailer, and inactive ingredients, and compared using paired, 2-tailed t tests (eg, Rogaine foam for men sold by CVS vs Rogaine foam for women, with identical inactive ingredients, sold by CVS). For each product, the largest volume available for sale was used. When prices differed for the same product at varied locations of the same chain, the mean price was used. Analyses were performed using Stata, version 12.1 (StataCorp). Two-sided P values <.05 were considered significant.
At 24 pharmacies in 4 states, 41 unique minoxidil products were identified: 14 for women and 27 for men. For 16 matched minoxidil solutions, price per 30 mL of product was not significantly different between women’s (2%) and men’s (5%) products with identical inactive ingredients (Table 1) ($7.61/30 mL vs $7.63/30 mL; P = .67). For matched minoxidil, 5%, foam products with identical inactive ingredients, there was a 40% mean increase in price per 30 mL of the product sold to women compared with men ($11.27/30 mL vs $8.05/30 mL; P < .001) (Table 2).
These findings show that women pay a price per 30 mL for 2% “regular-strength” minoxidil solutions similar to the price that men pay for 5% “extra-strength” minoxidil solutions. This variation could be a result of differential pricing by gender or could reflect production costs that are not related to medication strength. However, minoxidil, 5%, foams with identical active and inactive ingredients are priced significantly more per volume of the same product when sold to women compared with men. Although women use minoxidil foam once daily compared with twice daily for men, the group of people (women) who require the same medication less often are paying more for each dose.
Gender-based pricing discrimination in retail settings has been recognized for decades, and several state laws and local ordinances prohibit it,3,5,6 although these laws may be difficult to enforce. Whereas other consumer products might be differently formulated by gender, minoxidil foam products are identical medications sold to women and men separately. There are surely differences in costs of product testing, approval, and marketing between genders; however, it remains that women are paying significantly more than men for an identical medication.
Our study demonstrates differential pricing of minoxidil for men and women, even in the absence of ingredient differences. This may reflect the larger issue of gender-based pricing, which, to our knowledge, has not been previously shown for medications.
Accepted for Publication: March 30, 2017.
Corresponding Author: Jules B. Lipoff, MD, Department of Dermatology, University of Pennsylvania, Penn Medicine University City, 3737 Market St, Ste 1100, Philadelphia, PA 19104 (firstname.lastname@example.org).
Published Online: June 7, 2017. doi:10.1001/jamadermatol.2017.1394
Author Contributions: Drs Wehner and Lipoff had full access to all of 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: Wehner, Nead.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Wehner, Nead.
Administrative, technical, or material support: Lipoff.
Conflict of Interest Disclosures: Dr Lipoff received a Pfizer Independent Grant for Learning and Change from the American Academy of Dermatology. No other disclosures are reported.