The 20 Most Expensive Drugs in the U.S.A.

Turns out, more drugs are coming out with sky-high prices. Since May, three newly approved drugs have made their way into our most expensive list, and all 20 have a list price of more than $25,000 for a monthly supply. Some of these medications are for rare genetic disorders that afflict few people, while others treat more common conditions like pulmonary hypertension and hepatitis C.

Like our previous Top 11 most expensive list, we’ll update our Top 20 list monthly, keeping track of which medications are racking up the highest prices. Prices in this list are based on the list price, which is the price set by the manufacturer, for the previous calendar month (in this case, November 2018).

The 20 Most Expensive Drugs

1. Actimmune – $52,321

Approved for osteopetrosis and chronic granulomatous disease, a rare disorder that causes the immune system to malfunction, Actimmune is manufactured by Horizon Pharma. Patients typically take Actimmune three times a week, and on average will go through about 12 single-use vials a month at $4,360 per vial.

Luckily, manufacturer Horizon Pharma offers a Patient Assistance Program to help uninsured or low-income patients get Actimmune at no cost.

2. Daraprim – $45,000

You might recall that in 2015, Martin Shkreli sparked outrage for hiking the price of Daraprim from $13.50 per pill to about $750 per pill in a matter of days. While this caused a national conversation about drug prices and a class-action lawsuit, the price for Daraprim still remains high – with the list price for a one month supply (60 tablets) coming out to $45,000.

Daraprim is commonly given to AIDS and transplant patients to prevent infection and is used to treat toxoplasmosis in otherwise healthy people. Unlike other drugs on this list, patients are rarely on Dariprim for more than a couple of months.

3. Cinryze – $44,141

Manufactured by Shire, the list price for a typical one month supply (16 vials) of Cinryze runs at $44,140. Cinryze is used to treat hereditary angioedema, a rare life-threatening genetic condition that causes swelling in various parts of the body including hands, face and throat.

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

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4. Takhzyro – $44,140

Just like Cinryze above, Takhzyro is manufactured by Shire and is used to treat hereditary angioedema, and is the newest drug on this list. Approved just three months ago, patients typically need two vials per month at $22,070 per vial.

5. 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 Chenodiol increased five-fold. What’s more, Chenodal is currently off patent, which means the drug is technically legal for affordable generics to be manufactured. However, Chenodal is protected under what is referred to as a “closed distribution system,” preventing generic manufacturers from developing their own version.

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

6. Myalept – $42,137

Myalept is an orphan drug used to treat leptin deficiency in patients with generalized lipodystrophy. Myalept is self-administered once a day, and patients typically use 10 vials per month, at $4,213 per vial. Since Myalept is the only option to control this rare condition, there are no other cost-saving options available.

Aegerion Pharmaceuticals offers a co-pay card to help commercially insured patients afford Myalept.

7. H.P. Acthar – $38,892

H.P. Acthar, also referred to as Acthar, is used to treat multiple conditions like Lupus, rheumatoid arthritis, multiple sclerosis, infantile spasms, ophthalmic conditions, psoriatic arthritis and more. It is manufactured by Mallinckrodt Pharmaceuticals and was approved back in 2010.

Patients usually use one vial per month, which is priced at $38,892. Just like many drugs on this list, Acthar has also seen its fair share of price hikes. Back in 2001, when Acthar was still manufactured by Sanofi, the list price for one vial ran at about $40. 17 years and 1 new manufacturer later, the list price for one vial of Acthar runs at $38,892.

8. Juxtapid – $36,992

Juxtapid is manufactured by Aegerion Pharmaceuticals to treat people with homozygous familial hypercholesterolemia, a gene mutation that leads to cardiovascular disease. Patients typically take 28 capsules of Juxtapid per month with a list price of $1,321 per capsule.

9. Tegsedi – $34,600

Approved only five months ago, 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 vials per month with a list price of $8,650 per vial.

10. Firazyr – $32,468

Just like Cinryze mentioned above, Firazyr is manufactured by Shire for hereditary angioedema. However, unlike Cinryze, which is used to prevent swelling before an attack, Firazyr is used after an attack. Since patients suffer an average of two to four attacks per month, most fill one carton (three syringes) of Firazyr every month at a list price of $32,468.

11. Ravicti – $32,004

Ravicti is Horizon Pharma’s second drug on this list, after Actimmune, and is used to treat urea cycle disorders, a genetic disorder that results 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 two months, and the typical patient uses seven bottles in one month, at $4,572 per bottle of oral solution.

Just like Actimmune, uninsured or low-income patients can get Ravicti for free through the Horizon Cares Patient Assistance Program.

12. Harvoni – $31,500

Harvoni is manufactured by Gilead and is the first once-daily combination drug used to treat hepatitis C (HCV). Treatments for hepatitis C are notoriously expensive, and the cost for Harvoni is no different. Patients typically take Harvoni for 12 weeks, and a one-month supply runs at $31,500 for 28 tablets – $1,125 per tablet.

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