topical azelaic acid and oral tranexamic acid decreased at annual
rates of 33.6% and 7.6%, respectively. The cost of tretinoin cream
increased significantly from $0.70/g in 2013 to $4.14/g in 2014,
and then decreased gradually at a rate of 8.5% annually.
DISCUSSION
Overall, hydroquinone costs have decreased substantially over the past 7 years. Downward cost trends were also observed for off-label dyschromia therapies. Nevertheless, prescriptionstrength hydroquinone is the most effective treatment for melasma, comparable to triple combination cream (hydroquinone, tretinoin, and corticosteroid), and has remained the most affordable prescription treatment option.5
One limitation of our study is that NADAC is calculated only for medications covered by Medicaid and sufficient cost data submitted by retail pharmacies. Prescription tranexamic acid is not available in the US at doses used to treat dyschromia. For many patients for whom treatment of dyschromia is not covered by their insurance, out-of-pocket costs can be prohibitive.
The elimination of OTC sales of topical hydroquinone removes the most accessible treatment option for dyschromia patients, many of whom are not managed by prescription therapies. With decreased market competition from a lack of OTC alternatives moving forward, costs of dyschromia treatments should continue to be monitored to ensure that patients have affordable options to manage this often difficult-to-treat condition.
One limitation of our study is that NADAC is calculated only for medications covered by Medicaid and sufficient cost data submitted by retail pharmacies. Prescription tranexamic acid is not available in the US at doses used to treat dyschromia. For many patients for whom treatment of dyschromia is not covered by their insurance, out-of-pocket costs can be prohibitive.
The elimination of OTC sales of topical hydroquinone removes the most accessible treatment option for dyschromia patients, many of whom are not managed by prescription therapies. With decreased market competition from a lack of OTC alternatives moving forward, costs of dyschromia treatments should continue to be monitored to ensure that patients have affordable options to manage this often difficult-to-treat condition.
DISCLOSURES
The authors have no conflicts.
Data availability statement: The data that support the findings of this study are available in the Medicaid Pharmacy Pricing database at https://www.medicaid.gov/medicaid/prescriptiondrugs/ pharmacy-pricing/index.html
Data availability statement: The data that support the findings of this study are available in the Medicaid Pharmacy Pricing database at https://www.medicaid.gov/medicaid/prescriptiondrugs/ pharmacy-pricing/index.html
REFERENCES
1. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. Nov 2007;80(5):387-94.
2. Hydroquinone 4% cream [package insert]. Preferred Pharmaceuticals Inc; 2020.
3. H.R.748 - CARES Act. legislation. 116th Congress Public Law 136. Updated 03/27/2020. Accessed November 15, 2020, https://www.congress.gov/ bill/116th-congress/house-bill/748/text?fbclid=IwAR3ZxGP6AKUl6ce-dlWSU 6D5MfCLD576nWNBV5YTE7R2a0IdLY4Usw4oOv4
4. Congress Enacts OTC Monograph Reform. JD Supra. Accessed November 15, 2020, https://www.jdsupra.com/legalnews/congress-enacts-otcmonograph- reform-96907/
5. McKesey J, Tovar-Garza A, Pandya A. Melasma treatment: An Evidencebased review. Am J Clin Dermatol. 2020 Apr 2020;21(2)doi:10.1007/s40257- 019-00488-w
2. Hydroquinone 4% cream [package insert]. Preferred Pharmaceuticals Inc; 2020.
3. H.R.748 - CARES Act. legislation. 116th Congress Public Law 136. Updated 03/27/2020. Accessed November 15, 2020, https://www.congress.gov/ bill/116th-congress/house-bill/748/text?fbclid=IwAR3ZxGP6AKUl6ce-dlWSU 6D5MfCLD576nWNBV5YTE7R2a0IdLY4Usw4oOv4
4. Congress Enacts OTC Monograph Reform. JD Supra. Accessed November 15, 2020, https://www.jdsupra.com/legalnews/congress-enacts-otcmonograph- reform-96907/
5. McKesey J, Tovar-Garza A, Pandya A. Melasma treatment: An Evidencebased review. Am J Clin Dermatol. 2020 Apr 2020;21(2)doi:10.1007/s40257- 019-00488-w
AUTHOR CORRESPONDENCE
Eric J. Yang MD ericjyang@outlook.com
