How Much Does Accutane Cost?

• Isotretinoin is the generic version of the brand name Accutane, a vitamin A derivative that treats severe acne
• The cost varies due to several factors including acne severity and length of treatment
• Doctor’ visits, bloodwork and additional prescription drugs will affect overall costs
• Because there are so many variables, you may pay anywhere between $0–$400 for a 30-day supply

Isotretinoin is the generic version of Accutane, a discontinued brand name prescription medication used for severe forms of acne and for acne that is treatment-resistant. It’s now marketed under multiple brand names including Absorica, Amnesteem, Claravis, Myorisan and Zenatane, all of which are FDA approved. Your total Accutane cost depends on multiple factors ranging from your health insurance plan to length of treatment.

What Does Isotretinoin Treat?

Isotretinoin is a first-line treatment for disfiguring acne, including severe nodular and cystic acne, and for moderate-to-severe cases that fail to respond to traditional acne medications. 

Isotretinoin is also prescribed off-label to treat a number of inflammatory skin conditions such as psoriasis and rosacea. 

How Does Isotretinoin Work?

Isotretinoin is a powerful vitamin A derivative and an oral medication. It works systemically in several ways to provide long-term remission or substantial improvements in acne symptoms. 

Isotretinoin significantly reduces the production of sebum, the oil naturally produced by your skin, by shrinking sebaceous glands. It also prevents the formation of comedones (whiteheads and blackheads), lowers levels of acne-causing bacteria on the skin and indirectly, reduces inflammation.

What Affects the Cost of Isotretinoin?

Many factors affect the overall cost of your isotretinoin treatment, including whether you have health insurance and what your plan covers, doctor fees and how long your treatment lasts.

Health insurance

Health insurance is the largest factor in determining your personal cost for isotretinoin. If you’re unemployed or your employer does not offer health care, the Affordable Care Act can provide affordable health insurance plans to help reduce the overall cost of your treatment.

If you’re on Medicaid or Medicare, whether or not isotretinoin is covered depends on your plan and, for Medicaid, the state you live in.

Your dosage

Isotretinoin dosage is predominantly determined by how much you weigh. The standard dose is 1 mg per kilogram of body weight per day, although you may be prescribed from 0.5–2 mg/kg to reach the typical target cumulative dosage of 120–150 mg/kg. 

In some instances, even higher doses may be prescribed, regardless of weight. One study of adolescents with treatment-resistant acne found that relapse rates after 12 months were significantly lower in patients who received more than 220 mg/kg of isotretinoin than those who received less than 220 mg/kg, without increasing adverse events.

While taking a larger dose might improve your overall results, it will increase the cost of your treatment.

Length of treatment

Another factor to consider is the length of your acne treatment. The average course is 16–30 weeks. With a lower dose, you may experience fewer side effects but this may prolong treatment. 

Birth control 

Isotretinoin has been shown to cause severe or life-threatening birth defects in infants exposed during pregnancy. The risk of having a miscarriage can be as high as 40% if this medication is taken in early pregnancy. 

Because of these risks, the FDA requires providers of isotretinoin to enroll in its iPLEDGE program. This restricted distribution program ensures that only enrolled providers and pharmacies can provide isotretinoin to patients who adhere to its mandated birth control requirements. 

If you are of childbearing age, you must use two forms of birth control during treatment – typically birth control pills and condoms. This cost must also be factored into your overall cost. 

Additional medical fees

In addition to copays for your prescription, you may be responsible for other fees for doctor visits and blood tests. For instance, to start treatment, an initial visit with a doctor or dermatologist is needed to see if you are eligible for a prescription.

Regular doctor visits are sometimes required to check for pregnancy as well as triglyceride, cholesterol, white blood cell and platelet levels. Without insurance, lab work can become expensive and should be priced with your provider before starting treatment.

Additional doctor visits and prescription drugs to address side effects may be necessary as well. 

Reduced-cost programs

Reduced-cost programs can greatly decrease the cost of your prescription. 

Many websites offer discounts if you are paying out-of-pocket and tools to help you compare prices at large chain stores and pharmacies. In some cases, you can use discount cards from these websites at participating stores to increase savings.

Is Isotretinoin Worth It?

Although isotretinoin is considered highly effective, it’s associated with multiple rare, but serious, side effects. Given these risks, there are more factors than financial costs to consider when determining if this medication is right for you.

Side effects of isotretinoin

One 2017 study identified five common side effects of isotretinoin. In a review of more than 3,500 patients with moderate, severe or nodulocystic inflammatory acne:

• 100% reported dry lips
• 95% had abnormally dry skin
• 66% had facial redness
• 25% experienced psychiatric symptoms 
• 9% had eye lesions

These side effects were generally considered mild and were well-tolerated.

This medication is also associated with significant adverse events, including

• Depression
• Intracranial hypertension (pressure in the skull)
• Psychosis
• Suicide or suicidal ideation 
• Violent or aggressive behavior

However, a recent meta-analysis of 31 studies found no causal relationship between the medication and poor mental health. 

Should you experience any of these side effects, discontinue isotretinoin immediately and consult with your doctor.

Alternatives to isotretinoin

Two established oral antibiotics, doxycycline and tetracycline, are widely prescribed and have been shown to be effective against moderate-to-severe acne. 

A 30-day supply of a typical dose (500 mg/day) of tetracycline can cost between $40–$100 without health insurance. The equivalent supply of doxycycline (100 mg/day) has an average retail price of $96. Most of these costs can be reduced with health insurance, coupons or discount programs.

Takeaway

Isotretinoin, the generic version of Accutane, is a powerful oral medication that treats cystic and nodular acne, and recalcitrant moderate-to-severe acne. Isotretinoin is associated with some mild-to-severe side effects, including depression and psychosis. Rarely, it causes suicidal ideation, violence and aggression. 

The cost of isotretinoin varies widely depending on your health insurance coverage and length of treatment. Doctor’s visits, blood work and additional prescription drugs also affect the overall cost. However, reduced-cost programs can lower prescription costs, making treatment more affordable and accessible.