When Cheryl Kennedy of Chicago went to fill a pinworm prescription for her 4-year-old daughter, she was astounded to learn that four tablets of the drug Albenza cost almost $700—even with insurance.

"I called the doctor and asked if there was an alternative," Kennedy recalls. "That’s when he suggested we try an over-the-counter remedy" called Reese’s Pinworm Medicine that costs less than $15.

The OTC drug quickly cleared up her daughter’s pinworm, a common and highly contagious infection that affects 40 million Americans each year, most of them schoolchildren. Pinworm attacks the intestines and causes itching and rashes around the anus. (Get more information about pinworm and how to prevent it.)

Kennedy’s experience isn’t unusual. According to medical experts, doctors are routinely prescribing both Albenza (the brand name for albendazole) and another drug called Emverm (the brand name for mebendazole) without realizing how increasingly expensive they are. Both drugs are made by Impax Laboratories.

Albenza, for instance, has shot up from $6 per pill in 2010 to $190 per dose now; that same year mebendazole generic sold for about $16 per pill—and today, Emverm sells for about $430 per dose, according to Symphony Health, which tracks the pharmaceutical market.

Why Do Doctors Prescribe the Pricey Drugs?

"In the case of albendazole, the answer is very simple: Most doctors have no idea that an older, off-patent drug like albendazole could cost $200 per dose," says Jeremy A. Greene, M.D., Ph.D., professor of medicine and the history of medicine at Johns Hopkins University School of Medicine. “That is, until a patient comes back from the pharmacy in shock over the high price.”

Because the two drugs are old, "the average prescribing physician is conditioned to think that it must be very cheap,” Greene explains. “And they know also that it's a drug that's almost free in other countries. The concept that it could cost $200 per pill is unfathomable."

Consumer Reports’ own research suggests that doctors are often in the dark about drug prices. A poll last year of 200 internists showed that the biggest reason doctors have a hard time discussing drug costs with patients is that they don’t have access to prices or the patient’s insurance coverage. Yet 8 out of 10 doctors said they are concerned about their patient’s ability to afford treatments.  

"Even when physicians are concerned about prescribing affordable drugs, they have only limited tools available to understand the pricing implication that any given prescription will mean for their patients when they get to the pharmacy," notes Greene of Johns Hopkins.

High Price for a Cheap Cure

How both Albenza and Emverm came to be so expensive—especially when there’s a cheap OTC version available—highlights the confusing and contradictory nature of drug pricing in the U.S.

Albendazole was relatively inexpensive until 2010, when the manufacturer stopped making it. Amedra Pharmaceuticals later acquired marketing rights to the drug in 2013 and started raising its price from $6 per pill. Amedra was subsequently acquired by Impax Laboratories in 2015.

Mebendazole, meanwhile, was an inexpensive generic drug for decades, then went off the market in 2011. Amedra also purchased the rights to that drug, so it owned the only two prescription pinworm treatments available. The company was acquired by Impax Laboratories in 2015, and by January 2016 it launched a chewable version called Emverm, pricing it around $400 per pill. The inexpensive version of mebendazole is no longer available.

When Consumer Reports asked why the prices of both prescription drugs are so high, Impax spokesman Mark Donohue had this response:

"Emvern is the only FDA-approved prescription treatment for pinworm, with a 95 percent cure rate in a single tablet," Donohue said. He added that the company offers a savings card on Emvern's website.

Donohue said he couldn’t comment on albendazole. (The drug is used "off label," meaning it hasn’t been approved by the FDA for pinworm but is legal for doctors to prescribe.)   

Consumer advocates—including Consumers Union, the policy and mobilization arm of Consumer Reports—say a lack of federal regulations to curb such price increases means it could happen with other medications.

"The fact that the manufacturers of these once-affordable prescription drugs could get away with engineering such steep price hikes is one more demonstration that our current laws are not giving us a marketplace that works for consumers," says Victoria Burack, health policy analyst at Consumers Union. "We will continue pushing for Congress to fix those broken laws."

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).