Lauren Chase
February 8, 2021, 8AM (PT)
Key takeaways:
- The majority of drugs in the top 20 list continue to undergo price increases year after year.
- Orphan drugs, like Myalept and the newly approved Zokinvy, are some of the costliest drugs on the list.
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. The GoodRx Research team puts together a separate list of the most expensive drugs including those that must be administered by a medical professional.
While some of these expensive drugs haven’t seen changes since we updated the list in August, many have seen price increases, and we have a new most expensive drug.
- Zokinvy, a first-in-class orphan drug that won FDA approval in November 2020, tops the most expensive list this January.
- Twelve drugs, including four of the top five most expensive, saw price increases in January.
- Three drugs on prior lists — Solvadi, Viekira Pak, and Tibsovo — were bumped off by three new additions: Zokinvy, Orladeyo, and Idhifa.
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) Zokinvy – $86,040
Zokinvy, approved by the FDA in November 2020, is the newest drug to top the most expensive list. Zokinvy is an orphan drug — a drug that is intended to treat a rare disease. Manufactured by Eiger BioPharmaceuticals, this drug reduces the risk of death from Hutchinson-Gilford progeria syndrome, a rare genetic disease that causes premature aging. Zokinvy is a first-in-class drug and is the only drug approved to treat this condition, as there is no cure.
Although the dosage depends on body surface area, patients typically take around 200 mg of Zokinvy a day, and at $717 per 50 mg capsule, this adds up to $86,040 a month.
2) Myalept – $74,159
Myalept 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 $5,297 per vial. Since Myalept is the only option to control this rare condition, there are no other more affordable drugs available. Myalept increased in price this February, from $71,306 to $74,159.
Aegerion Pharmaceuticals offers a copay card to help commercially insured patients afford Myalept.
3) Mavenclad – $60,371
Mavenclad is used to treat relapsing forms of multiple sclerosis (MS). Patients take two treatment courses of Mavenclad, which are divided into two cycles. The courses are taken 12 months apart, but are expensive. The list price for one cycle of treatment in a course of Mavenclad is $60,371, up 6% from last year.
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) Ravicti – $57,998
Ravicti is one of two drugs on our most expensive list manufactured by Horizon Therapeutics. 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 comes as an oral liquid, and the typical patient uses 11 bottles in 1 month. The list price of Ravicti increased by 4.8% this January to $5,273 for one bottle.
For those looking to save, patients may be able to get financial assistance through Horizon Patient Services.Don’t miss out on savings!Get the best ways to save on your prescriptions delivered to your inbox. By signing up, I agree to GoodRx’s terms of service and privacy policy, and to receive marketing messages from GoodRx.
5) Actimmune – $55,310
Actimmune is also manufactured by Horizon Therapeutics 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. In January, Actimmune increased in price by 4.8%, bringing the cost for one vial up to $5,028.
Patients may be able to get savings for Actimmune through Horizon Patient Services.
6) 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’s Connect to Care program provides a copay card for commercially insured patients and a patient assistance program for eligible uninsured or underinsured patients.
7) Takhzyro – $46,828
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. Takhzyro increased in list price by 3% this January and now comes in at $23,414 per vial.
Through the OnePath Co-Pay assistance program, eligible commercially insured patients can get help covering treatment costs for Takhzyro.
8) Juxtapid – $46,502
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. Juxtapid increased in price by 4% this February to $1,661 per capsule.
Manufacturer Aegerion offers a Compass Copay program, which covers all copayments and coinsurance for eligible patients.
9) Cinryze – $45,465
Manufactured by Takeda, Cinryze has a list price of $45,465 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. In January, Takeda increased the price for one vial of Cinryze to $2,842 from $2,759.
Fortunately, commercially insured patients can get Cinryze for as little as $0 with the OnePath Co-Pay Assistance Program.
10) Chenodal – $42,570
Chenodal, used to dissolve gallstones, is manufactured by Travere Therapeutics (previously known as Retrophin), which was founded by Martin Shkreli, the same person responsible for Daraprim’s price hike. Back in 2014, while Shkreli was still CEO, 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.
11) Gattex –$41,664
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 $41,664, up 3% this January from $40,450.
Manufacturer Takeda offers the OnePath program that can assist patients with the insurance process, financial assistance options, and prescription delivery.
12) 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.
13) Orladeyo – $37,308
BioCryst Pharmaceuticals manufactures Orladeyo, a medication that can help treat hereditary angioedema. Orladeyo won FDA approval in December 2020, and is the only oral medication approved to help prevent attacks for this rare condition.
Typically, patients will take 1 capsule daily. At $1,332 per capsule, the total monthly cost for Orladeyo is $37,308.
For eligible commercially insured patients, BioCryst’s copay assistance program provides up to $40,000 a year to cover out-of-pocket expenses.
14) Tegsedi – $35,638
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. The list price for Tegsedi increased by 3% this January, and one carton of 4 syringes is now $35,638.
The Akcea Connect patient support program does not directly provide financial assistance, but can answer insurance questions and connect patients with outside resources.
15) Ayvakit – $33,568
Ayvakit is used to treat GIST and has a list price of $33,568 for a 30-day supply. Patients typically take 30 tablets per month with a list price of $1,119 per tablet. Ayvakit saw a price increase in January, up 4.8% from $32,000.
Manufacturer Blueprint Medicines offers a manufacturer copay program that can reduce co-pays to as little as $0. They also offer a patient assistance program.
16) 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 receive up to $25,000 a year of copay assistance though the TRAK Assist $0 Co-Pay Program.
17) Qinlock – $32,000
Qinlock, was approved by the FDA in May 2020 and 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 $356.
Manufacturer Deciphera provides AccessPoint, a program that can provide financial help including a commercial copay program, referrals to foundation funding, and a patient assistance program.
18) 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. The generic for Korlym was recently approved by the FDA, but is not yet available to patients.
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.
19) Cerdelga – $28,599
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 a few 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.
20) Idhifa –$28,246
Coming in last on the list is Idhifa, a medication that treats patients with acute myeloid leukemia (AML). AML is a fast-progressing cancer of the blood and bone marrow.
Idhifa received FDA approval back in 2017, but this January, the list price of a tablet of Idhifa increased to $941. The starting dose for patients is typically 100 mg a day, making the monthly cost for Idhifa around $28,246.
Manufacturer Celgene provides both a copay program and a patient assistance program, which may be able to help eligible patients afford Idhifa.
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