Skin dyspigmentation is a common dermatologic concern, particularly in patients with skin of color.1 Hydroquinone is often used as a first-line therapy for dyschromia, and is approved for treatment of melasma, chloasma, freckles, senile lentigines, and hyperpigmentation.2 Hydroquinone 4% cream is available only by prescription in the United States (US). Hydroquinone formulations with concentrations less than 4% were previously available over-the-counter (OTC), however sales were prohibited by the US Food and Drug Administration (FDA) as of September 25, 2020. Per the Coronavirus Aid, Relief, and Economic Security (CARES) Act and Over-the-Counter Drug Monograph Reform, hydroquinone is now recognized as Category II or not generally recognized as safe and effective.3,4 Given the high prevalence of dyschromia in the US population, our objectives were to investigate the cost trends of prescription hydroquinone, as well as other second-line alternatives for dyschromia, to evaluate affordability for patients.
National Average Drug Acquisition Cost (NADAC) data from
the Centers for Medicare & Medicaid Services from November
21, 2013 to October 21, 2020 were analyzed for this study. The
costs of hydroquinone 4% cream, tretinoin 0.025% cream, and
azelaic acid 15% gel per gram (g) and tranexamic acid per 650 g
tablet were calculated. Costs were adjusted for inflation to 2020
dollars by the Consumer Price Index for All Urban Consumers
(CPI-AUCSL) to allow for comparisons.
The cost of topical 4% hydroquinone was $1.01/g in October 2020, as compared to an inflation-adjusted cost of $2.97/g in 2013, representing an annual cost decrease of 14.5%. Comparatively, costs of topical azelaic acid 15% gel, tretinoin 0.025% cream, and oral tranexamic acid were $2.24/g, $2.39/g, and $2.29/650 g tablet, respectively, in October 2020 (Figure 1). The costs of