Expensive cheap drugs

December 24, 2015 11:10 AM

I was accompanying a friend who was picking up a prescription for nitroglycerin pills at a supermarket pharmacy and was surprised to see that the price was $30 for around 20 pills (he doesn't have insurance so this was retail price, not a copay). I was curious so I checked Walmart's list of $4 drugs and found nitroglycerin is not on the list. I checked a drug price comparison website and it also listed prices in the $20-30 range. Nitroglycerin has been used medically for 130 years (no patent) and seems like it can't be expensive to make, I thought for sure it would be dirt cheap like generic prozac, amoxicillin, etc. Anyone have an idea/theory why it's so expensive?
posted by duoshao to Health & Fitness (7 answers total)

Sometimes there are shortages and the price goes up. Check the ASHP site for bulletins on drug shortages.
posted by discopolo at 11:31 AM on December 24, 2015 [2 favorites]

Best answer: This article from 2014 has some info - basically what discopolo said.
posted by bluefly at 11:37 AM on December 24, 2015

Best answer: I have performed FDA remediation work in the pharma industry. The article that bluefly linked to is very good. The standards to which pharma companies are held constantly increase. It takes a while for new knowledge to translate to better manufacturing. It is also very expensive. Processes that were standard 20 years ago are no longer acceptable because we know better. But that means that companies have to invest money to improve those processes and facilities and there is really no financial incentive for them to do so when the drugs are cheap and off patent.
posted by kamikazegopher at 11:54 AM on December 24, 2015 [1 favorite]

FYI in some places (Ontario, Canada for one), Nitroglycerin (the spray for sure, probably tablets, but not the long acting patches) is actually an 'over the counter' drug...meaning it is available without a prescription, which can save you on 'pharmacy fees'. It may be asking if this is the case for a jurisdiction near you. It was roughly $25 for 100? doses in a spray bottle.
posted by Northbysomewhatcrazy at 12:49 PM on December 24, 2015

The Walmart $4 list and other such lists are really intended to be filled with loss leaders, so making it on the list has less to do with the actual cost of the drug (although obviously they can't offer truly expensive drugs for $4) than it has to do with how easy the drug is to sell, which is a combination of a lot of factors including how many people take the drug, how often they take it (daily vs. "as needed" vs. short courses of antibiotics), how easy the drug is to procure, etc. Nitroglycerin isn't making the cut for some combination of reasons, probably including availability but also maybe nitroglycerin-takers just aren't as attractive as customers for some reason (too few of them, too old, whatever).

Amoxicillin doesn't exactly "cost" $4 either, but they sell it to you for $4 in hopes that you'll also buy shampoo and a bathing suit and transfer all your other retail-price prescriptions to their pharmacy.
posted by mskyle at 1:21 PM on December 24, 2015 [3 favorites]

In the specific case of Nitroglycerin, it also happens to be, you know, a dangerous explosive, which I imagine makes it significantly more expensive to manufacture in drug form.
posted by neckro23 at 9:57 AM on December 26, 2015

Drug prices vary quite a bit. See this story from Consumer Reports: http://www.consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices
posted by teddyb109 at 5:02 PM on December 26, 2015 [1 favorite]