(HealthDay News) — Market forces are dramatically driving up the cost of some generic drugs, prompting U.S. investigations into the pricing of what should be cheap alternatives to brand-name medications.

Generics that should cost pennies per dose have undergone radical increases in price in recent years, Aaron Kesselheim, MD, JD, MPH, author of a new commentary in the New England Journal of Medicine, told HealthDay. Kesselheim is the director of the Program on Regulation, Therapeutics and Law at Brigham and Women’s Hospital in Boston.

For example, the widely used broad-spectrum antibiotic doxycycline has increased from 6.3 cents to $3.36 per pill. And the long-established antidepressant drug clomipramine has increased from 22 cents to $8.32 per pill, Kesselheim noted in his commentary. 

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Supply chain and manufacturing problems have caused some of these price hikes, he said. But Kesselheim believes that other increases have resulted from too few companies making the generic versions of these drugs. 

“We take for granted that generic drugs are low-cost, but they’re only low-cost because there’s competition. When that competition goes away, the prices rise,” said Kesselheim. “Because we leave this up to the free market, this is a risk we take on.”

In response to these increases, both the U.S. Senate and the U.S. Department of Justice have undertaken investigations into generic drug pricing. Federal prosecutors have issued subpoenas to two generic drug makers, seeking information about possible collusion between competitors, according to a published report. 

At the same time, the Senate Subcommittee on Primary Health and Aging has sent letters to executives of 14 pharmaceutical companies asking for answers, and on Nov. 20 will hold a hearing into the matter.


  1. Alpern JD, Stauffer WM and Kesselheim AS. N Engl J Med. 2014;371:1859-1862.