The pink tax

Some drugs are associated with a 40% higher cost for women

A recent study showed that female hair loss patients may be paying more than their male counterparts for the same hair loss medication. Researchers found that compared to men, women can pay on average 40 percent more for minoxidil foam (Rogaine, J&J Consumer Center Inc.) for hair loss treatment.

“Although gender-based price differences are not new for consumer products (the so called ‘pink tax’), I believe this is the first study analyzing and comparing the pricing of medication according to gender. People may not necessarily feel like they have a choice if they are recommended to try something by their doctor,” said Jules B. Lipoff, M.D., a dermatologist with the University of Pennsylvania, and co-author of the study published June 7 in JAMA Dermatology.

Androgenetic alopecia, also known as male pattern or female pattern baldness, is the most common type of hair loss affecting about 50 million men and 30 million women in the United States. There are several therapeutic modalities and remedies currently being employed for androgenetic alopecia, including the over-the-counter minoxidil, which is FDA-approved for the treatment of androgenetic alopecia in men and women. 

Minoxidil is available as a 5% solution for men and a 2% solution for women. In 2006, the FDA approved 5% minoxidil foam for men to be applied twice daily and in 2014, the same foam was approved for women to be used once a day.

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Dr. Lipoff and colleagues recently conducted a study collecting data on 41 minoxidil products between July and November 2016 from four states and 24 national chain pharmacies including CVS, Kroger, Rite Aid, Target, Walgreens and Walmart and compared them by retail price. The prices of minoxidil solution and foam were compared per 30 ml (one ounce) of the product.

Data showed that for 16 matched minoxidil solutions with identical inactive ingredients, the price per 30 ml of 2% solution for women averaged to $7.61, compared to $7.63 per 30 ml of 5% solution for men. It was also found that the price per 30 ml of 5% minoxidil foam was $11.27 for the product marketed to women, compared to $8.05 for the product marketed to men. This amounts to a 40% more expensive minoxidil foam product for women containing identical inactive ingredients.

“We need to be transparent about how much things cost and where those costs are derived from. Although gender-based price differences among consumer products may be legal, our findings open up a lot of different ethical questions when we see the same medication cost different amounts for different people,” Dr. Lipoff said.

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The variation in costs could be a result of differential pricing by gender or could reflect production costs that are not related to medication strength. If one product costs different among genders, Dr. Lipoff said that it is possible that other healthcare expenditures, other procedures, and other medications could be charged differentially as well, which could lead to disparities in healthcare and discrimination.

Physicians are generally not aware of how much medications cost when prescribing them. Although not every physician should be expected to talk about this issue, Dr. Lipoff believes it is the responsibility of the physician to be aware and to consider cost when they prescribe treatment in their patients.

According to Dr. Lipoff, it is important to be cost-effective and there are a lot of ways to achieve that in the American healthcare system.

“I think any dermatologist treating alopecia who wants to prescribe or recommend minoxidil to female patients should recommend to women to use the ‘for men’ product. I believe it is important on a global scale to be aware of how much things cost, and how these costs may affect different groups of people differently,” Dr. Lipoff said.

REFERENCES

Wehner MR, Nead KT, Lipoff JB. “Association between gender and drug cost for over-the-counter minoxidil.” JAMA Dermatology. Jun 7, 2017. DOI: 10.1001/jamadermatol.2017.1394