The 20 most expensive pharmacy drugs in the U.S. in 2020, from fallen blockbusters to new orphan meds

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Amryt's Myalept is the most expensive pharmacy medicine in the U.S., per a new GoodRx ranking. (CC0 from Pixabay)

Drug pricing remains a hot topic, and a new report offers some reasons: The most expensive drugs sold at pharmacies can cost as much as a luxury car—every month. And GoodRx's latest ranking of the country's costliest drugs include brands new and old.

According to the GoodRx tally, the most expensive pharmacy meds in the U.S. this year range from $71,306 per month for Amryt’s Myalept to $27,421 for Agios’ Tibsovo. Several drugs that appeared on 2019's list make a repeat appearance with higher price tags. Two brands entered the ranks for the first time.

All of the prices are before rebates and discounts, and the list excludes medicines administered in a doctor's office or hospital, so many of the industry's costliest drugs are excluded. For instance, pharma's gene therapies—including Novartis' $2.125 million Zolgensma—aren't listed.

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In 2020, Myalept remains the most expensive pharmacy drug in the U.S. at a whopping $71,306 per month. The drug, which treats complications caused by leptin deficiency in people who have lipodystrophy, has had numerous owners over the years, and its latest, Amryt, raised its price by 9.9% in January. Aegerion had marketed the med until September, when Amryt bought that drugmaker out of bankruptcy. 

RELATED: Amryt buys Aegerion via bankruptcy, adding sales to support R&D 

Horizon Therapeutics' Ravicti, a staple on expensive drug rankings, takes No. 2 at $55,341 per month. The med treats urea cycle disorders and was among the drugs that got a higher price in January.

Another of those? Horizon's own Actimmune, which captured the No. 4 spot on GoodRx's list at a sticker price of $52,777 per month. The company increased the prices on Ravicti and Actimmune by 4.9% in January, Jefferies analyst David Steinberg wrote in a note at the time. 

Meanwhile, the first newcomer on the list is Merck KGaA’s multiple sclerosis med Mavenclad. The drug scored an FDA nod in March 2019, and its sales are helping the drugmaker offset the decline of its older Rebif. Mavenclad costs $53,730 per month, making it the third most expensive drug sold at U.S. pharmacies. 

A representative for the company said Mavenclad is taken orally for two weeks at the start of treatment, and then for two weeks one year later. Mavenclad isn't a monthly treatment, she added, so the GoodRx monthly price doesn't reflect its dosing schedule.

Blueprint Medicines’ stomach cancer med Ayvakit, which costs $32,000 per month, is the other newcomer in the ranking, taking the No. 15 spot.

RELATED: In crowded MS market, Merck KGaA's Mavenclad now offsets Rebif decline 

Rounding out the top 5 is Dompé’s Oxervate, which won FDA approval to treat rare eye disease neurotrophic keratitis. The med carries a list price of $48,498 per month. A Dompé spokeswoman said Oxervate isn't taken as a monthly therapy, so its inclusion in the rankings doesn't reflect its dosing schedule. 

Out of the entire group, seven meds are more expensive than they were last year, GoodRx says. Perhaps the most commercially successful of the medicines was Gilead's Sovaldi, the first of a new generation of hepatitis C drugs that raked in megablockbuster revenue before competition started eroding sales.

Please view the chart below for the entire rankings. 

Editor's note: This story was added to add context around dosing for Mavenclad and Oxervate. 

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