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Why are Some Retinoids so Expensive?

January 18, 2021

high drug prices

American consumers have become resigned to paying more than just about every other country for their prescriptions. From statins that manage high cholesterol to men's health drugs like Viagra, even the most commonly prescribed drugs are extraordinarily expensive in the United States compared to global standards.

Moderate to severe acne sufferers are often prescribed retinoids — compounds derived from vitamin A to help improve skin tone and texture. They have also become very popular in cosmetic products available over the counter for the role they play in managing the signs of aging, like fine lines, wrinkles and sun damage. Retinoids are also prescribed to treat other skin conditions like melasma, psoriasis, and some types of cancer.

There are many types of retinoid products, some of which are available over the counter, while others must be prescribed — and of course, prices for prescription retinoids tend to vary. Some prescriptions can be significantly more expensive than others depending on where you buy them, the level of insurance coverage you have, the availability of coupons and manufacturer rebates, and the type of retinoid you're using, among others.

Different Types of Prescription Retinoids

Retinoids cover a broad category of products, from prescription medications for severe acne and skin problems, to cosmetic anti-aging products sold over-the-counter (OTC) or online. While retinol-based products and medications are derived from vitamin A, they have varying concentrations and chemical compositions that can have harsh side effects on the skin if they're used incorrectly or in the wrong dosage.

Therefore, it's always a good idea to consult with a dermatologist before using a retinoid product — even those available to purchase over the counter. The dermatologist will likely have insight into how retinoid products can best be used with your unique skin. Additionally, they may have brand recommendations based on their own experience and that of their other patients.

Some of the most commonly prescribed retinoid medications include:

  • Tretinoin - Renova, Retin A, Stieva, Ziana, Vesanoid, Melacare, Atralin, Refissa, Tri-Luma
  • Tazarotene - Tazorac
  • Isotretinoin - Accutane, Amnesteem, Zenatane, Claravis, Absorica, Myorisan

Retinoid prescriptions are typically for topical applications and can come in gel, cream, or serum form. Retinoid medications vary in concentration depending on factors such as the severity of the acne or skin condition, as well as individual skin type, and whether you're taking other medications (people with sensitive skin types may have reactions to retinoid products, so a dermatologist may recommend a lower concentration).

With so many brands and product variations, pricing can vary considerably, especially for American consumers.

Why Do You Need a Prescription for Retinoids?

Over the past couple decades, retinoids have become a standard ingredient of many cosmetic and skincare products that are available on grocery store and drug store shelves. Furthermore, vitamin A itself is a naturally occurring substance in food and is available as a supplement. All of this begs the question: why is a prescription necessary for some retinoid products, such as tretinoin and Retin-A?

Over-the-counter cosmetic creams and serums can be useful for anti-aging purposes. Goals of smoothing the texture of the skin, minimizing the appearance of common signs of aging (like pigmentation and fine lines and wrinkles) can be accomplished to some degree with something you'd find at your local grocery store.

For milder cases of acne, an over-the-counter retinol product with a lower concentration may be enough to treat breakouts and lower the risk of scarring, but OTC products will always be less powerful than the prescription versions. For more serious cases of acne, a prescription retinoid medication will be more appropriate.

Prescription grade retinoids consist of much higher concentrations. While the higher concentration generally makes them more effective, the dosages also have to be regulated for safety and to manage the risk of side effects. In the United States, products like retinoids are marketed as a type of fountain of youth that can "turn back the clock" (more on that later) and help create perfect skin, but sensitive skin types may be more prone to side effects.

Retinol products trigger cell turnover on the skin to boost collagen production and rapid growth of new cells. The prescription-grade retinoids available at higher concentrations may show results over the course of a few weeks, whereas a retinol-based commercial product will generally work more slowly, with results only becoming apparent over the course of a few months. (Of course, most people become frustrated with the lack of results by that point and either stop using the product or talk to their dermatologist about a prescription.)

Retinoid products can sometimes make the skin look (or feel) worse in the beginning and cause peeling, dryness, redness, and sensitivity to the sun. If you have sensitive or delicate skin or suffer from acne, using a product that's too harsh for your skin can lead to scarring or make the problem worse. Again, it's always best to consult with a dermatologist before using a retinoid product.

Non-Cosmetic Uses for Retinoids

In addition to treating acne, retinoids are also prescribed sometimes to cancer patients. While not a major component in the same way that chemotherapy and radiation may be used, retinoids are sometimes incorporated into a cancer treatment plan because of the role they play in signaling cell differentiation and maturity.

Retinoids are effective when used as one small part of an overall treatment plan in some forms of cancer — they are not applicable in all cases. The types of retinoids used in cancer therapy are also derivatives of vitamin A but differ from the compounds used to treat acne and premature aging. Isotretinoin, a retinoid used in cancer therapy, is administered orally in the form of a pill.

How Much Do Retinoids Cost?

As is the case with most prescription medications in the United States, there isn't a standard pricing model for retinoids. (And let's face it: there seems to be little rhyme or reason to the prices pharmaceutical companies set for their drugs in the U.S.)

What we do know with certainty is that there are multiple variables that affect the price of every prescription medication:

  • Name brand vs. generic - There are many varieties of retinoids in both name brands and generic versions, which can help decrease the price, provided the specific drug you seek has both a name brand and a generic.
  • Your insurance plan - There are multiple types of insurance plans (PPO, EPO, HMO, HDHP) and each provides varying degrees of coverage and pricing. Generally speaking, the higher your premiums, the lower your copays for prescriptions, and vice versa. In the case of HDHPs, you're expected to pay the full amount for all prescriptions until you've reached your deductible, at which point, you'll probably still be expected to pay at least a portion of the amount (perhaps 50%).
  • Your individual pharmacy - Believe it or not, the price of your prescription can vary based on the pharmacy you choose. You could pay more for the exact same medication because you went to a pharmacy chain over another. It's all about the deal struck between the insurance company, the pharmacy benefit manager (PBM), and the pharmacy itself. Additionally, purchasing straight from a PBM could save you money as well (of course, not nearly what you'd save by purchasing from an online Canadian pharmacy and international drugstore).
  • Your location - As with any other good or service, the physical location of your pharmacy and residence can play a role. What someone pays in a major metropolitan area may be higher than what someone pays in a smaller market.

As frustrating as it may seem — especially considering the fact that everyone seems to be short on time at all times — the best way to find the lowest prices available for a retinoid prescription is to shop around. By looking at a few different sources (both brick and mortar and online), you're very likely to find that there are more affordable options available to you that are also incredibly convenient.

The Hidden Costs of Retinoids

There are many hidden factors in the cost of retinoids (and essentially, every other pharmaceutical that is made). The manufacturing process, distribution, advertising and marketing costs (in the United States), and whatever research and development costs the manufacturer would like to claim will all play a role in how much the end user will ultimately pay for the product.

With medications like retinoids, the process of manufacturing a gel or cream that can effectively preserve and deliver a working dose of the active ingredient is a bit more complicated than making a basic vitamin A supplement for oral ingestion. And by no means will cracking open a capsule of vitamin A and smearing it on your skin have the same effects as a prescription retinoid.

For example, retinol products have to be transformed into retinoic acid through enzymes in order to work, so retinol based products are typically weaker and have lower concentrations than Retin-A, which is a retinoic acid that can be absorbed directly into the skin to produce results. They're both a type of retinoid, but a higher concentration retinol product is generally less powerful than a Retin-A prescription even at very low dosages.

Additionally, topical creams and gels have a limited shelf life, meaning that they cannot be on pharmacy shelves or in a warehouse for longer than a specific window of time before they'll be deemed unusable and ineffective. Even after the product is sold, there will be a window in which the cream or gel should be used. It's unlikely that the product would become harmful, per se, but it wouldn't work in the same way that it should.

Retin-A prescriptions are covered by some insurance plans depending on the provider and the specific terms of the plan. As such, there are many variables that affect what an individual consumer will pay for a prescription in the U.S. On average, a 20-gram prescription of Retin-A (approximately 0.7 ounces) retails for about $75 (tretinoin is the generic version of Retin-A and costs roughly half at about $40).

Even with prescription drug coverage of a generic retinoid like tretinoin, the out-of-pocket copay costs can range from a few dollars to hundreds of dollars, the main factor in this case being the dosage. Some plans will only cover a specific type of prescription, as in the case of certain Medicare prescription plans which may cover the generic prescription but not the Retin-A (brand name) version.

The Pharmacy Difference

For American consumers, another important factor in how much a prescription will cost is where it gets filled. It may be convenient and time efficient to fill out your prescription at the local CVS or Walgreens while you shop for groceries your household necessities, but many corporate pharmacy chains don't adhere to universal or standard pricing models. As previously mentioned, the exact same prescription and dosage can range from just a few to a hundred dollars or more from one pharmacy chain to another.

Our customers are often surprised at the difference in price between their local pharmacies, so when they check the lower prices we can offer for the exact same medication (at the exact same dosage, delivered straight to their doors), they're frequently shocked. This fact is particularly frustrating for people who live in border states. It can be dismaying to find that a business just a few miles away can sell a medication at such a different price.

The Cultural Factor

When setting the prices for retinoids, one must consider the cultural factors at play. Some people are rather self-conscious about their appearance, and if you're looking into a retinoid prescription, you might fall into this category — at least a little bit.

The fact of the matter is that we're bombarded with pictures of beautiful people all day long. Every movie, every television show, every advertisement is full of people who appear to live up to impossibly high beauty standards. People see this content and compare themselves to the most objectively beautiful people on the planet whose images have been touched up and digitally enhanced. Who doesn't want to know Jennifer Aniston's skin care secrets?

What we don't see as consumers is the amount of work that goes into each one of these shoots. Every single movie, TV show, and advertisement has a huge team of people behind it that is entirely dedicated to impeccable beauty — makeup artists, lighting experts, photographers, videographers, editors (Photoshop is a remarkable tool), and directors who are dictating exactly the image they wish to distribute to the world. There is nothing natural about the media we consume.

Furthermore, celebrities are conscious of the fact that cameras will catch every single imperfection, and most of them take this very seriously. As any dermatologist or skin care expert will tell you, healthy skin starts with what we eat. Most actors (especially women) maintain strict diets full of greens and devoid of grease. They drink tons of water to flush out their bodies, and they exercise regularly.

Of course, they also have rigorous skin care routines — ones they're more able to afford since they have more money. They can afford the eye creams, the prescription retinoids, the 8-step bedtime routine, and the facemasks with gold flakes in them. In many ways, all of this work can be seen as an investment in the same way that high quality shoes and equipment are for athletes.

If you've ever seen behind the scenes footage of celebrities prepping for red carpet events, you'll see an entire team of people around them, and many times, you'll see little strips under their eyes to make their dark circles less visible. Oftentimes they do special face treatments in the days leading up to the event. And all of this is before the makeup artists even go to work.

And finally, one cannot overlook that women are judged more harshly than men when it comes to beauty and aging. Women are implicitly taught from a young age to care about their appearance — and to be fair, so are men — but the cosmetics industry is heavily geared toward women. Anti-aging products are everywhere, telling women that they can turn back the clock and erase those fine lines and wrinkles. Of course, the actresses selling the products have a few other tricks up their sleeves helping them hide the signs of their own aging.

Given the impossible standards we see every single day, it's really no wonder that the beauty industry is valued at over $500 billion — and drug manufacturers understand very well that people will pay whatever they can to have skin that more closely resembles their favorite celebrity.

How to Save Money on Your Retinoid Prescription

Even with health insurance and prescription drug coverage, many Americans find it difficult to afford the medication they need on a regular basis. Customers without health insurance are the hardest hit because the retail price for the average prescription is usually much higher than normal. While people with high deductible health plans (HDHPs) are required to pay out-of-pocket for nearly everything until they reach their deductible, the price they pay is the negotiated rate between the provider and the insurance company.

If you have insurance, check with your plan provider before filling your prescription to find out what they cover, and how much you will be expected to pay out-of-pocket, which usually includes co-pays as well as deductibles for many plans.

Depending on the type of retinoid that your doctor prescribes, there may be a cheaper generic version available. Keep in mind that generic and brand name versions of a medication may contain different filler ingredients or concentrations of active ingredients, so you should always consult with your doctor and pharmacist on every prescription to ensure that you're getting what you expect.

Because generic medications must follow the same dosage guidelines as their brand name counterparts, it's generally safe to assume that if the pharmacist fills a generic prescription instead, you don't need to be worried about any difference in the instructions. However, if you notice any adverse side effects (especially if you switched from the brand to the generic), be sure to keep a log. Sometimes, people experience aversions to the filler ingredients in prescriptions.

Generic versions are not always available and, in some cases, may not be a good substitute for the brand name version, but they are often a good place to start when trying to save money on certain prescriptions.

Manufacturer and Pharmacy Rebates, Discounts, and Coupons

Some pharmacies and pharmaceutical companies offer discounts and rebates on some of their prescriptions. While they may not always be available or come with certain restrictions, it's generally a good practice to ask and see what's available before paying full price for a prescription (even with insurance).

This can be as simple as doing an internet search (Googling, if you will) for coupon codes and rebates for your specific medication. Pharmaceutical companies clearly know that some people struggle to cover the costs, since many commercials feature the same words at the end: If you cannot afford your prescription medication, [insert pharmaceutical company name here] may be able to help.

To be clear, these discount cards and rebates will be helpful in the United States but are unlikely to work with online pharmacies internationally. The good news is that the price you find online very well may be cheaper than the price you'd get with the coupon code.

Price Check Your Pharmacist

Many over the counter cosmetic products contain retinoids, but unlike a jar of face cream which may cost about the same whether you buy it at CVS or Target, the same doesn't hold true for prescription retinoids.

Even if the price range and savings on an individual prescription isn't significant, it can add up over time, especially for prescriptions that require refills. Become familiar with what the pharmacies you use are charging so that you can make informed decisions before dropping off your prescriptions.

The same goes for price-checking Canadian online pharmacies and international ones. At NorthWestPharmacy.com, we offer a low-price guarantee, meaning that if you can find your medication cheaper elsewhere, we'll match it.

Are Retinoids Cheaper in Canada or Internationally?

More and more Americans are finding much needed relief from expensive prescription medications through online Canadian pharmacies and international drug stores. Depending on the prescription in question, the savings available through an online pharmacy can be significant for American consumers.

Here are some examples of typical prices for tretinoin and Retin A at NorthWestPharmacy.com:

  • Retin A (cream) - 30 grams
    • Strength: 0.025% - $24.79
    • Strength: 0.05% - $21.69
  • Retin A (cream) - 20 grams
    • Strength: 0.1% - $22.79
  • Retin A (gel) - 20 grams
    • Strength: 0.025% - $19.09
    • Strength: 0.05% - $19.09
    • Strength: 0.10% - $25.19

For contrast, a 20-gram tube of tretinoin (0.025%) in cream form starts at about $53.00 in the United States. A 15-gram tube of the same concentration in gel form starts at about $81.00. And of course, these prices will vary, depending on multiple factors.

In some cases, a generic alternative of a prescription medication that's available in the United States may not be available to purchase from an international online pharmacy (such as the retinoid product called Renova cream).

The standards for safely shopping and buying your prescriptions from an online Canadian pharmacy are the same as with filling your prescriptions at your local pharmacy down the street — there are strict regulations in place to ensure safety standards. But as with purchasing anything else online, it's a good idea to take extra precautions to ensure that you're shopping at a legitimate business and getting an authentic product. In the case of online international pharmacies, there are organizations dedicated to oversight that you can rely on to determine the legitimacy of the online pharmacy.

Specifically, checking to see that the online pharmacy you're considering is certified by independent third-party organizations such as CIPA (Canadian International Pharmacy Association). Furthermore, you can look into the rating of each pharmacy, and you can learn more about how Canadian pharmacies are rated here.

Many prescription drugs are generally cheaper in Canada and other industrialized nations due to strict government regulation and price control measures. These regulations are in place to keep medications more affordable, which is something that the American government has chosen to skip altogether.

Because online international pharmacies are legitimate businesses facing oversight from third party organizations, they will still require obtaining a valid prescription from a licensed doctor. When you place your order, you'll need to produce a copy of the prescription, which will be verified by staff members. If a pharmacy claims to operate legally and offers to sell medication without a prescription, consider that a red flag — a major one, in fact.

NorthWestPharmacy.com is dedicated to helping our American customers save as much money as possible on prescriptions. Our customer service team is available to answer all of your questions about your prescriptions and how to safely place an order online. For more information about our products and ordering process, call our toll-free number 1-866-539-5330 to speak to a customer service representative, or contact us online.

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