Influence of Market Competition on Tetracycline Pricing and Impact of Price Increases on Clinician Prescribing Behavior

Oral tetracyclines are commonly used for acne and other conditions. Recent generic price increases threaten access to these medications. Using the OptumInsight Clinformatics DataMart, we retrospectively evaluated the underlying factors behind these price increases for oral tetracylines using the framework of a competitive market and evaluated the impact of these price increases on prescribing practices. Between 2011 and 2013, the mean cost of doxycycline hyclate prescriptions increased from $7.16 to $139.89 and the mean out-of-pocket cost increased by $9.69. A comparable cost increase was not observed for doxycycline monohydrate or minocycline. There was no significant association between the cost of doxycycline hyclate and market concentration as assessed by the Herfindahl-Hirschman index (beta = 0.030, 95% confidence interval -0.019 to 0.079, P = 0.213) and the market was highly concentrated throughout the study period. The percentage of prescriptions for doxycycline hyclate decreased by 1.9% from 2011 to 2013. This dramatic increase in the cost of doxycycline hyclate is not easily explained using the framework of a competitive market, suggesting that noncompetitive market forces may be responsible. In addition, clinicians have not altered their prescribing behavior in response to this price increase, suggesting that clinician or pharmacy level interventions could potentially increase the use of less costly substitutes.