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In recent years, the number of new drugs approved by the FDA has reached record highs. With this situation, the pricing of specialty drugs is getting higher and higher, and the prices of some new technology therapies that have not yet been approved are even more jaw-dropping. According to Reuters, Novartis recently revealed that the pricing of gene therapy may exceed $1 million per person.

Analysts at GoodRx, the US drug price tracking website, recently listed the top 20 drugs in the US pharmacy. Of course, because it is a retail calibre, this list does not include some high-priced star drugs for drug administration in doctors’ offices or hospitals.


US pharmacy retail price TOP20 drugs (USD / month)

From the above table, it can be found that the pharmacy retail price of TOP20 is between 300,000 and 600,000 US dollars per year, some of which are produced by unknown small pharmaceutical companies, and some are produced by large pharmaceutical companies of the global TOP level. The drugs on the list are mostly orphan drugs, but there are similar drugs for hepatitis C, which cover millions of patients. Gilead, AbbVie, and Shire all have drugs on the list. However, the price here is the retail price. Since many pharmaceutical companies provide patient assistance programs, they will each have corresponding reimbursement compensation or discounts. The actual drug burden of patients may be much smaller than the marked price.


NO.1 Actimmune – $52,321 / month

Actimmune (Interferon gamma-1b) is produced by Horizon Pharma and is approved for the treatment of rare immune system diseases of osteopetrosis and chronic granulomas. Inject 3 times a week, with an average of 12 injections per month, each at a price of $4,360.

Horizon Pharma offers a patient assistance program, and some patients with no insurance or low income can get free injections.


NO.2 Daraprim – $45,000/month

If you are impressed with the news of the 2015 bad boy Martin Shkreli’s imprisonment, you should not be unfamiliar with this drug. It is Martin Shkreli who raised the price of Daraprim, a drug used to treat Toxoplasma infection in AIDS or organ transplant patients, from $13.5 per tablet to Hungry for $750 per tablet. The price is hugely controversial.

Daraprim’s monthly (60 pieces) retail price is $45,000. Unlike other drugs on the list, patients who take Daraprim usually do not exceed months.


NO.3 Cinryze – $44,141 / month

Cinryze (C1 esterase inhibitor), produced by Shire, is the first and currently the only treatment in the United States to help prevent the onset of angioedema in a 6-year-old pediatric hereditary vascular water (HAE) patient. HAE is a rare genetic disease with a worldwide incidence of about 1/50000-1/10000. The disease can cause recurrent episodes of edema (swelling) in different parts of the body, including the abdomen, face, feet, genitals, hands and throat, which can cause pain and weaken the patient. The HAE episode that blocks the airway is potentially life-threatening due to the risk of suffocation.

Cinryze is priced at $44,140 per month (16). Shire has a OnePath Co-Pay Assistance Program that allows patients with Medicare to spend as little as $0 on Cinryze.


NO.4 Takhzyro – $44,140/month

Takhzyro (lanadelumab-flyo) is another drug produced by Shrie for the prevention of seizures in patients with hereditary angioedema (HAE) 12 years of age and older. It is the first monoclonal antibody to prevent HAE attacks. It has just received FDA approval on the 23rd, with 2 injections per month, each priced at $22070.


NO.5 Chenodal – $42,570/month

Chenodal is used to help patients with gallstones, produced by Retrophin. The reason for the list is that Martin Shkreli mentioned above raised the price of Chenodal by five times during his tenure as CEO of Retrophin in 2014.

Although Chenodal has lost patent protection, a “closed distribution system” has prevented generic drug manufacturers from developing the drug. Chenodal costs $473 per piece. Most patients with gallstones need to take 90 tablets per month, but some patients take up to 210 tablets per month.


NO.6 Myalept – $42,137/month

Myalept (metreleptin) is produced by Aegerion Pharmaceuticals Inc. for the treatment of leptin deficiency in patients with systemic lipodystrophy. It is an orphan drug. Patients are given subcutaneous injections once a day, 10 bottles per month, and the price is $4,213 per bottle. . Since Myalept is the only drug to treat this rare disease, there are no other, more cost-effective drugs to choose from. Aegerion Pharmaceuticals provides a co-payment card for patients with commercial insurance to reduce patient costs.


NO.7 Acthar – $38,892 / month

Achthar is a hormone drug extracted from the pituitary of pigs. It is produced by Malnkkrdt Pharmaceutical Company and approved in 2010 for the treatment of lupus, rheumatoid arthritis, multiple sclerosis, infantile spasm, ophthalmic diseases, psoriatic arthritis. And many other diseases. Patients usually use one bottle per month for $38,892. Achthar is also on the list for several times. In 2001, when Acthar was produced by Sanofi, the price of a bottle was about $40. But after replacing the new producer in 2017, the price of a bottle of Acthar soared to $38,892.


NO.8 Juxtapid – $36,992 / month

Juxtapid (lomitapide) is produced by Aegerion Pharmaceuticals Inc. for the treatment of homozygous familial hypercholesterolemia. Patients usually take 28 capsules per month for $1312 each.


NO.9 Tegsedi – $34,600/month

Tegsedi (inotersen) is an antisense oligodeoxynucleotide (ASO) inhibitor of human transthyretin (TTR) protein synthesis, used in the treatment of hereditary transthyretin amyloidosis (hATTR) in adults. Or stage 2 multiple neuropathy. Approved by the FDA on October 5, patients need to receive appropriate dosing technology training, usually 4 bottles per month, the price of each bottle is 8650 US dollars.


NO.10 Firazyr – $32,468 / month

Firazyr is another hereditary angioedema drug produced by Shire, but unlike Cinryze, it is used prophylactically before HAE, but after HAE. Since HAE patients have an average of 2-4 episodes per month, most patients use Firazyr’s monthly treatment cost (a box of 3 prefilled syringes) for $32,468.


NO.11 Ravicti – $3,2004/month

Ravicti is Horizon’s second high-priced drug for the treatment of urea cycle disorders, a genetic disease that causes high levels of ammonia in the blood. If left untreated, urea cycle disorders can lead to coma and even death. The drug is intended for children 2 months of age, with 7 patients per month for a typical patient, priced at $4,572 per bottle. Like Actimmune, Ravicti is also available for free through patient assistance programs.


NO.12 Harvoni – $31,500/month

Harvoni is the first daily oral compound hepatitis C drug developed by Gilead. As a curative treatment, oral hepatitis C drugs are relatively expensive in the United States, Harvoni is no exception, each piece is priced at $ 1,125, patients take 12 weeks for a course of treatment, and taking 28 tablets per month costs $ 3,500.


NO.13 Cuprimine – $31426 / month

Cuprimine (penicillamine hydrochloride) is the oldest drug on the list and is produced by Valeant to treat copper accumulation caused by Wilson’s disease. The patient took one capsule after each meal and the price was $261.89. The price of Cuprimine has always been a hot topic, and even sparked debate in the US Congress.

NO.14 Sovaldi – $28,000 / month

Produced by Gilead, Sovaldi is the world’s first oral cure for hepatitis C. Pricing is $1,000 per tablet, and patients take 12 weeks as a course of treatment for $28,000 per month.


NO.15 Viekir Pak – $27,773/month

Viekira Pak is produced by Abbott and approved for the treatment of hepatitis C in 2015. Viekir Pak is a two-in-one cocktail therapy. Patients need to take 2 tablets containing ombitasvir, paritap and ritonavir daily, and 1 tablet containing dasabuvir. Since a daily oral whole-genogen hepatitis C drug is available, Viekira Pak is no longer the first-line treatment option for hepatitis C.


NO.16 Viekira XR – $27,773/month

Viekira XR is a sustained release formulation of Viekira Pak for the treatment of patients with type 1 hepatitis C. It also contains 4 pharmaceutical ingredients, but patients only need to take 1 tablet per day.


NO.17 Orfadin – $27,247 / month

Orfadin (nitisinone) is used to treat type 1 hereditary tyrosinemia. Hereditary tyrosinemia is a rare hereditary disease that prevents the body from breaking down tyrosine, leading to dysplasia, jaundice, liver and kidney failure. Type 1 is the most serious type of tyrosinemia. Symptoms generally begin. In the first few months of birth. The therapeutic dose of Orfadin varies from patient to patient, but most patients usually need to take 30 capsules of 20 mg per month for $908 each.


NO.18 Zavesca – $26,820/month

Zavesca (miglustat) is used to treat type 1 Gaucher’s disease. Gaucher disease is a “common” lysosomal storage disease that causes fat accumulation in the liver, kidneys and bone marrow. Patients usually take 90 capsules per month for a price of $26,820.


NO.19 Tibsovo – $26,115 / month

Tibsovo (ivosidenib) is an inhibitor of the isocitrate dehydrogenase 1 (IDH1) enzyme, used to treat acute myeloid leukemia, and was approved by the FDA in July this year. Prior to obtaining FDA approval, Cornerstone also introduced ivosidenib’s China development rights. Tibsovo’s monthly treatment cost is $26,115.


NO. 20 Remodulin – $25,466/month

Remodulin is produced by United Therapeutics for the treatment of pulmonary hypertension. Patients usually require 2 bottles per month, and each bottle is priced at $12,733. United Therapeutics has a patient assistance program that allows low-income patients to get Remodulin at a discounted price.

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