If you’re one of the 50 million Americans who experience acne annually, you’re no stranger to the embarrassment and discomfort the condition can cause.
Although acne is often thought of as a teenage problem, it can affect people at any stage of their lives and often continues well into their 30s and 40s. An estimated 85 percent of adolescents and young adults between the ages of 12 and 24 experience some type of acne, and although many people experience only minor breakouts, for others, acne can become severe.
Americans spend more than two billion dollars per year trying to treat their acne, but sometimes, only one option remains. When acne becomes moderate to severe and doesn’t respond to other treatments such as tetracycline or absorica, a powerful dermatology drug called Accutane can be used to clear breakouts.
Accutane was first introduced to the market in 1982, and this notoriously expensive drug is known to be extremely effective, but it comes with a long list of serious side effects. As generic forms of the drug entered the market, the cost of the medication has come down, so how much does Accutane cost today?
What is Accutane?
Accutane was first approved for the treatment of acne by the U.S. Food and Drug Administration (FDA) in 1982. Known today under its generic name, isotretinoin, the brand-name drug Accutane was discontinued by the manufacturers in 2009.
Today, most people still refer to the drug by its brand name, however. Accutane is a derivative of vitamin A that is delivered at an extremely high dose. The medication belongs to a class of drugs known as retinoids and is related to drugs like Retin-A.
Accutane has been prescribed more than two million times and has been extensively studied due to the high risk of side effects associated with the medication.
What Is Accutane Used to Treat?
Accutane is used to treat moderate-to-severe forms of acne that have not been resolved by other types of treatment. Accutane use is most commonly tied to cystic or nodular acne, but it can also be used to treat other types that have not responded to treatment.
Cystic acne is characterized by large, painful breakouts that form deep under the skin. It is commonly caused by clogged pores that trap bacteria, which is what causes normal pimples. With cystic acne, the infection becomes lodged deeper into the skin and creates a pus-filled cyst.
Cystic acne can form on a person’s face, back, chest, upper arms, or shoulders, and it is more common in men. The condition can leave permanent scars that are very difficult to reduce later in life.
How Does Accutane Work?
If you can believe it, Accutane actually works by altering DNA transcription in the body. When DNA transcription is altered, the size of the sebaceous, or oil-producing, glands in the body is reduced, and they produce less oil.
Your skin cells change as well, by becoming less “sticky,” which makes them less likely to form blackheads and whiteheads, which are the clogged pores that many of us think of when we think of acne.
Additionally, the amount of bacteria in the sebaceous glands and on the skin is reduced. Because Accutane is a naturally occurring derivative of vitamin A, it actually already exists within all of our bodies naturally. By adding a larger dose of this derivative, the body’s DNA begins to change.
How Much Does Accutane Cost?
Accutane has a reputation for being extremely expensive due to the monopoly it holds on the market for treating severe acne. The reality is that no other medication can treat severe acne as effectively.
The brand-name form of the drug has been off the market since 2009, and today, there are other manufacturers producing isotretinoin capsules. Isotretinoin is now sold under the brand names sotret, Claravis, Amnesteem, Myorisan, and Senate.
The cost of Accutane can vary widely depending on the type of insurance you have, with co-pays ranging from 0 to 700 dollars or more. People with health insurance, including Medicare and Medicaid, will usually have some type of coverage for Accutane.
However, the medication also requires monthly doctor’s visits due to the risks associated with taking the drug. These costs can combine to make Accutane extremely expensive. The cost of the medication also varies based on the dosage taken each day, which varies per person.
Although Accutane is expensive, it normally only needs to be taken for four to six months before your skin is cleared. Although some people may need an additional course of treatment, either immediately following the first treatment or several years later, this is fairly uncommon.
If the cost of Accutane is preventing you from taking the medication and you do not have health insurance, consider joining a pharmacy discount card program like USA Rx. USARx provides discounts on all FDA-approved medications, regardless of whether they are generic or name brand, and there are no registration costs or eligibility requirements.
Why is Accutane so expensive?
Isotretinoin is expensive because it is the only drug of its kind. Even though there are multiple drug manufacturers producing isotretinoin under different names (other than Accutane, which has been discontinued), it remains the sole prescription option that can powerfully and effectively treat severe acne.
What affects the cost of Accutane treatment?
The biggest factors that will affect your Accutane cost include:
1. Whether or not you have coverage from your health insurance plan
Most insurance plans in the U.S. cover Accutane. It’s also covered by Medicare and Medicaid. Insurance copays can vary by plan, but RealSelf members put the low end at $25 per month.
While the full cost of Accutane without health insurance is high, you could reduce your cash price to as little as $90 a month for a 30-day supply of isotretinoin, Claravis, myorisan, amnesteem, or pentane (generic versions of brand-name Accutane, which is no longer being manufactured) by taking advantage of online coupons from pharmacy discount card providers.
Sites USA Rx, GoodRx, and SingleCare negotiate discounts with different pharmacies to dramatically reduce the cost of prescription drugs like this one.
2. The length of your treatment
A standard course of Accutane treatment runs from 16 to 20 weeks. Approximately 85% of patients don’t need more isotretinoin treatment beyond this period, but those dealing with particularly stubborn cystic acne might need a second course.
3. Copays or other fees for monthly doctor visits and blood tests
While you’re on Accutane or any form of isotretinoin, you’ll need to register for the FDA’s which requires women of childbearing age to agree to use two forms of birth control while taking the drug.
Before you start your treatment course, your doctor will need to order blood tests to assess your cholesterol and triglyceride levels and confirm that your kidney and liver functions are normal.
For female patients, they will also need to confirm and record the results of two negative pregnancy tests (blood tests, since urine-based pregnancy test results can be unreliable) prior to issuing your prescription.
After that, you’ll need to visit your doctor monthly, so they can enter the results of a negative pregnancy test before your refill will be authorized. You’ll also be required to get monthly lab tests to check that your previously tested levels are stable.
All of these monthly lab tests and doctor visits will come with fees. Depending on your insurance plan, these costs may be covered partially or fully, but at minimum, expect to pay a copay.
4. Mental health support.
While some studies show that isotretinoin’s effective acne treatment can actually improve mental health, it has also been linked to depression and thoughts of suicide.
Even if you’ve never struggled with depression in the past, pay special attention to your mental health during your treatment, and consider whether you may need to pay for a few sessions with a good therapist or counselor.
RealSelf Tip: One of the most common side effects of Accutane is severely dry skin. Talk with your dermatologist about affordable ways to modify your skincare routine to prevent dryness, flaking, and peeling (particularly around your lips). You might also need to purchase eye drops to reduce irritation from dry eyes.
What Side Effects and Risks Are Associated With Accutane Use?
Accutane is an extremely effective acne treatment for severe acne, but it is accompanied by many risks and side effects. The general categories of risks and side effects associated with Accutane are outlined below.
Reproductive System
Accutane causes severe birth defects that can cause miscarriage, death of the fetus, or premature birth. The effects of Accutane on unborn children are so severe that the FDA developed a program called in order to prevent pregnancy in women taking Accutane.
Under the women of childbearing age must use at least two forms of birth control pills while taking Accutane, must undergo a monthly pregnancy blood test, and must take a monthly quiz about contraceptive methods in order to receive their prescription each month.
The prescription must be filled within a certain number of days after the negative pregnancy test result is received. Birth defects caused by Accutane are known to include:
- Hearing loss
- Missing eyes
- Small or missing thymus gland
- Congenital heart defects
- Small or missing ears
- Small eyes
- Cleft palate
- Hydrocephalus, or buildup of fluid on the brain
- Underdeveloped brain and small head (microcephaly)
Women should not get pregnant for at least four weeks after stopping Accutane.
Mental Health
Accutane is known to adversely affect mental health for some patients, including those who have never experienced mental health issues before.
Depression, psychosis, and suicidal ideation and behaviors can increase in patients taking Accutane, so it is important that family and friends pay close attention for warning signs. Warning signs associated with declining mental health include:
- Emotional outbursts
- Visual or auditory hallucinations
- Withdrawal
- Suicidal thoughts
Skin and Hair
It is common for people taking Accutane to notice that their acne gets worse before it starts to get better. Side effects impacting the skin and hair associated with Accutane include:
- Dry skin, sometimes severely dry
- Chapped lips
- Dry nasal passages, which can result in nose bleeds
- Increased sun sensitivity
- Faint yellowing of the skin
- Skin becomes more fragile and peels
- Thinning hair
Due to the increased sensitivity of your skin, while taking Accutane, hair removal procedures or other harsh skin treatments should not be performed while taking Accutane or for six months after use.
Central Nervous System
Accutane also affects the central nervous system and commonly causes side effects like headaches and tiredness. Other side effects associated with the central nervous system include:
- Dry eyes
- Difficulty seeing in the dark
- Ringing in the ears
- Hearing loss, which can become permanent
- Mood changes, including irritability or sadness
In rare cases, Accutane can cause increased pressure in the brain, which can be life-threatening. Symptoms of pressure in the brain include:
- Blurred vision
- Severe headache
- Dizziness
- Vomiting
- Nausea
- Seizures
- Stroke
Digestive Tract
Accutane can cause uncomfortable side effects that impact digestion and excretion. Common side effects include:
- Bleeding gums
- Heartburn
- Bowel pain
- Nausea
- Diarrhea
- Joint pain
- Rectal bleeding
- Reduced appetite
- Stomach pain
- Dark urine
- Vomiting
- Inflammatory bowel disease
Most patients taking Accutane will undergo regular lab testing by their dermatologist to make sure that their organs are still functioning properly and that their cholesterol levels are stable.
If you experience any of the side effects listed above, it may be a sign that your esophagus, liver, pancreas, or intestines are being damaged by the medication, so make sure to tell your doctor about any side effects that you are experiencing.
Other Side Effects
Because Accutane levels can build up in your bloodstream just like vitamin A, you may experience changes to your blood sugar and lipid levels. Your doctor will likely order lab work each month to make sure your levels are stable.
White and red blood cell counts may also decrease while taking Accutane, resulting in weakness, feeling faint, or difficulty breathing. Some people experience pain in their bones, muscles, ligaments, and joints while taking the medication. Remember to seek medical advice if you aren’t feeling well while taking the prescription drug.
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