Lauren Chase
Lauren Chase is on the Research Team at GoodRx.
Posted on August 11, 2020

In an effort to continue to shed light on drug prices and increase transparency, the GoodRx Research Team regularly tracks the most expensive drugs in the U.S. Since 2018, we have tracked the list price and dosing requirements to identify the most expensive drugs.

Here we look at the most expensive drugs that patients can get at a pharmacy and administer themselves. This list does not include medications that must be administered by a healthcare practitioner. In March, the GoodRx Research team put together the list of the most expensive drugs including those that must be administered by a medical professional.

While many of these expensive drugs haven’t seen price changes since we updated the list in February, there are some notable changes:

Daraprim, the controversial drug that caused a national conversation about drug prices, has been removed from the list as it finally got a generic.
Qinlock, a medication that treats gastrointestinal stromal tumor (GIST), is the only newly approved drug added to the list.
Other new additions to the list include Cerdelga and Korlym.
Kynmaro and Viekira XR, which were previously on the list, were both discontinued.
Mavenclad increased in price by 6% in April 2020.
The following are the 20 most expensive medications in the U.S., based on the list price — the price a manufacturer assigns as the official price of a drug. While few patients actually pay the list price, as they are typically shielded by their health insurance, the list price is still a good proxy for the price of a drug.

1) Myalept – $71,306
Myalept is an orphan drug — a drug that is intended to treat a rare disease. It is used to treat leptin deficiency in patients with generalized lipodystrophy, a condition of abnormal fat distribution in the body.

Myalept is self-administered once a day, and patients typically use 14 vials per month at a list price of $5,093 per vial. Since Myalept is the only option to control this rare condition, there are no other more affordable drugs available. Myalept most recently increased in price in January, from $64,859 to $71,306.

Aegerion Pharmaceuticals offers a copay card program to help commercially insured patients afford Myalept.

2) Ravicti – $55,341
Ravicti is one of two drugs on our most expensive list manufactured by Horizon Pharma. It is used to treat urea cycle disorders, which are genetic conditions that result in high levels of ammonia in the blood. If left untreated, urea cycle disorders can lead to confusion, coma, or even death. Ravicti can be used in children as young as 2 months of age, and the typical patient uses 11 bottles in 1 month. The list price for one bottle of Ravicti is $5,031.

For those looking to save, uninsured or low-income patients can get Ravicti for free through the Horizon Patient Services.

3) Mavenclad – $56,954
Mavenclad is used to treat relapsing forms of multiple sclerosis (MS). Patients take two treatment courses of Mavenclad, 12 months apart, but the courses are expensive. The list price for a course of Mavenclad increased 6% in April, from $53,730 to $56,954.

Manufacturer EMD Serono offers a copay card that can reduce out-of-pocket costs to as little as $0 per prescription, but the program is only for commercially insured patients.

4) Actimmune – $52,777
Actimmune is manufactured by Horizon Pharma and is approved for osteopetrosis and chronic granulomatous disease, a rare disorder that causes the immune system to malfunction. Patients typically take Actimmune 3 times a week, and on average, go through about 11 single-use vials a month.

The list price is $4,797 per vial. However, manufacturer Horizon Pharma offers a patient assistance program to help uninsured or low-income patients get Actimmune at no cost.

5) Oxervate – $48,498
Approved in 2019, Oxervate is the first drug available to treat neurotrophic keratitis, a degenerative condition that leads to the reduction of sensitivity in the cornea. Patients will usually go through 28 vials of Oxervate in a 4-week period. The list price for Oxervate is $1,732 per vial.

Thankfully, manufacturer Dompe provides a copay card for commercially insured patients and a patient assistance program for eligible uninsured or underinsured patients.

6) Takhzyro – $45,464
Takhzyro is manufactured by Takeda and is used to treat hereditary angioedema, a condition characterized by severe swelling in the body. Approved in late 2018, patients typically need 2 vials per of Takhzyro a month at $22,732 per vial.

Through the OnePath Co-Pay assistance program, eligible patients can get help covering treatment costs for Takhzyro.

7) Juxtapid – $44,714
Juxtapid is manufactured by Amryt Pharmaceuticals and treats people with homozygous familial hypercholesterolemia, a gene mutation that leads to cardiovascular disease. Patients typically take 28 capsules of Juxtapid per month, and each capsule has a list price of $1,597.

8) Cinryze – $44,141
Manufactured by Takeda, Cinryze has a list price of $44,141 for a typical one-month supply (16 vials). Cinryze is used to treat hereditary angioedema, a rare, life-threatening genetic condition that causes swelling in various parts of the body including the hands, face, and throat.

Fortunately, commercially insured patients can get Cinryze for as little as $0 with the OnePath Co-Pay Assistance Program.

9) Chenodal – $42,570
Chenodal, used to dissolve gallstones, is manufactured by Retrophin, which was founded by Martin Shkreli, the same person responsible for Daraprim’s price hike. Back in 2014, while Shkreli was still CEO of Retrophin, prices for Chenodal increased fivefold.

What’s more, Chenodal is currently off patent, which usually means manufacturers can start making affordable generics of the brand-name drug. However, Chenodal is protected under what is referred to as a “closed distribution system,” which prevents manufacturers from developing their own generic versions.

While most patients take 90 tablets per month, some can take as many as 210 at a whopping list price of $473 per tablet.

10) Gattex – $40,450
Used to treat short bowel syndrome, a condition that causes diarrhea resulting in malnutrition and dehydration, Gattex costs over $40,000 per month. In May 2019, Gattex won FDA approval to treat short bowel syndrome in children 1 year of age and older. Patients typically go through 30 vials of Gattex per month, with the list price for a carton of 30 vials coming in at $40,450.

Manufacturer Takeda offers the OnePath program that can assist patients with the insurance process, financial assistance options, and prescription delivery.

11) H.P. Acthar – $39,864
H.P. Acthar, also referred to as Acthar, is used to treat multiple conditions like lupus, rheumatoid arthritis, multiple sclerosis, infantile spasms, ophthalmic conditions, and psoriatic arthritis. It is manufactured by Mallinckrodt Pharmaceuticals and was approved back in 2010.

Just like many drugs on this list, Acthar has seen its fair share of price hikes. Back in 2001, when the drug was still manufactured by Sanofi, the list price for one vial ran at about $40. Seventeen years and one new manufacturer later, the list price for one vial of Acthar (a typical monthly supply) now runs at $39,864.

Financial assistance is available through Mallinckrodt’s copay and patient assistance programs. Patients must meet certain criteria to be eligible.

12) Tegsedi – $34,600
Tegsedi is used to treat nerve damage caused by hereditary transthyretin amyloidosis, a rare and slow-progressing disease caused by a buildup of proteins in organs and tissue. After patients are trained on the proper administration techniques, they typically use 4 syringes per month. A carton of 4 syringes has a list price of $34,600.

13) Vitrakvi – $32,800
Manufactured by Bayer Pharmaceuticals, Vitrakvi is a cancer drug used to treat patients with a specific gene mutation. Patients typically take 60 capsules a month, and each capsule has a list price of $547.

Patients with commercial insurance can get Vitrakvi for as little as $0 with the TRAK Assist $0 Co-Pay Program.

14) Qinlock – $32,000
The newest addition to the most expensive drugs list, Qinlock, was approved by the FDA in May 2020. Qinlock is the first drug for the fourth-line treatment of advanced gastrointestinal stromal tumors (GIST), which are tumors in the gastrointestinal tract.

Patients typically take 3 tablets a day, and each tablet has a list price of $355.

Manufacturer Deciphera has a commercial copay program that proves financial help if you have non-government insurance. If you are uninsured, they also have a patient assistance program.

15) Ayvakit – $32,000
Like Qinlock, Ayvakit is also used to treat GIST and has a list price of $32,000 for a 30-day supply. Patients typically take 30 tablets per month with a list price of $1,067 per tablet.

Manufacturer Blueprint Medicines offers a manufacturer copay program that can reduce co-pays to as little as $0. Unfortunately, the card is for commercially insured patients only.

16) Korlym – $31,440
Korlym was approved in 2012 and is used to treat hypocortisolism, also known as Cushing’s syndrome. This disease causes high levels of the hormone cortisol in the body. While this drug has no generic equivalent, its active ingredient is mifepristone, which costs much less if used as an abortion pill.

Patients can take a range of 30 to 120 tablets a month, but many patients take 60. Each tablet has a list price of $524.

The manufacturer, Corcept Therapeutics, provides financial assistance for eligible uninsured patients, as well as copay assistance for commercially insured patients.

17) Sovaldi – $28,000
Manufactured by Gilead, Sovaldi is a popular medication used to treat hepatitis C. Treatments for hepatitis C are notoriously expensive, and the cost for Sovaldi is no different. Patients take Sovaldi for 12 weeks; the list price for a one-month supply runs at $28,000, or $1,000 per tablet.

Gilead offers a copay coupon program, but it is only for patients with commercial insurance.

18) Viekira Pak – $27,773
Viekira Pak is one of the two drugs on this list used to treat hepatitis C. Approved in 2015, Viekira Pak is used to treat hepatitis C genotype 1, the most common hepatitis C genotype (strain) in the U.S.

Viekira Pak is a package of two different kinds of tablets. Each day, patients are instructed to take two of the tablets containing ombitasvir, paritaprevir, and ritonavir and one of the tablets containing dasabuvir.

Since its approval, multiple hepatitis drugs have been released that treat all hepatitis C genotypes and don’t require as many pills per day, so Viekira is no longer a first-line treatment.

19) Tibsovo – $27,421
Approved in July 2018, Tibsovo is the first treatment for acute myeloid leukemia in patients with a specific genetic mutation. While it is an orphan drug that fills an unmet need, Tibsovo has a list price of $457 per tablet, making it unaffordable for most. Patients usually take 60 tablets in a one-month period.

20) Cerdelga – $27,300
Another new addition to the most expensive list, Cerdelga, is used to treat patients with Gaucher disease type 1 and received FDA approval in 2014. Gaucher disease type 1 is a genetic disease in which fat builds up in the liver, spleen, and bone marrow.

Cerdelga is one of the only oral treatments for adults with Gaucher disease type 1. Patients usually take 2 tablets of Cerdelga a day. With a list price of $487.50 per tablet, the cost for a one-month supply is $27,300.

Manufacturer Genzyme’s CareConnectPSS Copay Program can help patients with commercial insurance afford Cerdelga.

Methodology

We created a list of the most expensive drugs by list price, excluded drugs that are administered under the supervision of a healthcare provider, and obtained typical fill quantities using data and information from the drug manufacturer websites to compare the monthly price of these drugs. Using the official manufacturer list price, we calculated the total cost of a 1-month supply of a typical fill quantity. For drugs where there is a large effective dosing range, or where patient weight determines dosing, we selected a dosing quantity based on claim volume.

Prices in this analysis are the list price, which is the price the pharmaceutical company assigns as an official price for a drug. While few people actually pay the full price of a drug out of pocket, as they are typically shielded by their health insurance, more and more people are on the hook for the price of their drugs every year due to high-deductible insurance plans and formulary changes. What’s more, high-priced drugs end up raising insurance rates and overall healthcare spending, which trickles down to patients in the end.