A few times a year, insurance companies update the list of prescription drugs their plans will cover, adding and removing certain medications from their formularies. In the last couple of years, doxycycline, a popular antibiotic, has been moved on and off different formularies, making some versions prohibitively expensive for those in need of the effective treatment.

What is doxycycline, and why is it so expensive?

Doxycycline has been around since the ‘50s and is commonly prescribed for a range of bacterial infections. It is the first-choice therapy for tick-borne illnesses, like Lyme disease, and is often used to treat acne, rosacea, urinary tract infections, and chlamydia. It’s available in 2 main compositions (more on that later).

Doxycycline also comes with a lot of baggage—it’s perhaps the best case study of unseemly price hikes. In 2011, the retail price of generic doxycycline increased by 1,854%. The following year, a separate price increase, this time due to a shortage, caused it to go up 6428%. In 2013? 9145%. These astronomical jumps have spurred congressional investigations into possible price-fixing schemes by several drug manufacturers.

Are all doxycycline products affected by these price hikes?

Fortunately, no. Below is the current list of exclusions from 3 major pharmacy benefit managers who administer coverage plans for more than 250 million Americans combined. If you’re prescribed one of these doxycycline variations, you will find that the out-of-pocket cost is surprisingly high.

Express Scripts

CVS Caremark

OptumRx

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I can’t afford my doxycycline prescription. What are my options?

First, the good news: You have a lot of other doxycycline options. Generic doxycycline monohydrate and generic doxycycline hyclate are both available in oral capsule and tablet forms. The main difference is that doxycycline hyclate is more water soluble and therefore more likely to cause side effects as it passes through the gastrointestinal tract. They are generally thought to work the same, but to combat the side effects, delayed and further-delayed versions of doxycycline hyclate were developed to make it more tolerable. (Strictly speaking, brand-name Oracea and its generic are also considered delayed-release. Each pill contains 30 mg of immediate-release and 10 mg of delayed-release doxycycline monohydrate.)

The bad news: Not every option is cheap, even if it’s covered. Even if a drug is on a formulary, each health plan designates different drugs to different pricing tiers, which helps determine what your drug costs with your insurance. Sometimes this is the case for different versions, forms, and strengths of the same drug, too. Generic doxycycline hyclate and doxycycline monohydrate are considered “preferred” drugs, but they may still end up costing a lot depending on what exactly you’re prescribed.

As we see in the 2020 Express Scripts formulary, doxycycline hyclate DR 80 mg is excluded from coverage while all other strengths of doxycycline hyclate DR are covered.

Bottom line: If you find that the doxycycline you’ve been prescribed is too expensive, chances are that another variation, form, or strength of doxycycline may be available for less.

What about the preferred alternatives?

Preferred alternatives listed by insurers are medications considered to be as effective as their excluded counterparts. They also tend to be more cost-efficient for the insurance company and as such, are typically generics. However, brand-name medications may be recommended over generic counterparts when the insurer and drug manufacturer have negotiated rebates to encourage the use of brand-name medications.



For example, Express Scripts (ES) covers Oracea (used to treat rosacea) but not its generic, doxycycline 40 mg capsules. According to MMIT, Oracea is a tier 2 drug on 62% of ES commercial plans and a tier 3 drug for the rest (and sometimes a prior authorization is required). For ES commercial plans, tier 2 drugs are preferred brands, meaning copays will be slightly more expensive than if ES covered the generic version, which would be a tier 2, preferred generic drug. Tier 3 drugs are deemed non-preferred brands and will have the highest out-of-pocket costs under your plan.

But if you’re one of the 38% of ES customers who can’t afford the generic doxycycline 40 mg capsules because it’s not covered, nor brand-name Oracea because it’s covered but still expensive, you’re in luck as there are plenty of other options, doxycycline or not.

What other alternatives are there for doxycycline?

If your healthcare provider prefers to put you on another treatment altogether, they may suggest another tetracycline antibiotic or an antibiotic in another drug class. Here are some common doctor-recommended alternatives based on your health issue:

Acne and rosacea

Chlamydia and uncomplicated gonorrhea

Urinary tract infection

Lyme disease and Rocky Mountain spotted fever

How do I save on doxycycline?

Check GoodRx for the lowest price. Always see if there is a lower price available on the GoodRx website or mobile app, especially if your copays are too expensive or if you don’t have insurance. With GoodRx, you can save up to 80% off the average retail price of doxycycline monohydrate and 94% off the average retail price of doxycycline hyclate.

Always see if there is a lower price available on the GoodRx website or mobile app, especially if your copays are too expensive or if you don’t have insurance. With GoodRx, you can save up to 80% off the average retail price of doxycycline monohydrate and 94% off the average retail price of doxycycline hyclate. Ask your doctor about other forms of doxycycline. Prices can vary quite a bit based on the variation, form, or strength you’re prescribed. Doxycycline monohydrate, doxycycline hyclate, and their delayed-release versions should work similarly to treat your condition. Patients may find that they prefer one over the other due to certain side effects.

Prices can vary quite a bit based on the variation, form, or strength you’re prescribed. Doxycycline monohydrate, doxycycline hyclate, and their delayed-release versions should work similarly to treat your condition. Patients may find that they prefer one over the other due to certain side effects. Buy in larger quantities. If you need to take doxycycline for longer than a couple of weeks, like in the case of acne treatment, it may be worth looking at prices for larger quantities. For example, when comparing GoodRx prices for doxycycline hyclate 100 mg, a prescription for 60 capsules is 34% cheaper per pill than a prescription for 20 capsules.