What pharmacies paid for six generic antidepressants, 2013 to 2026

In October 2026, retail pharmacies paid an average of 3.5 cents for a generic 50 mg sertraline tablet, according to the National Average Drug Acquisition Cost survey¹ that the Centers for Medicare & Medicaid Services runs for Medicaid. A 20 mg fluoxetine capsule cost 2.9 cents. Citalopram and trazodone tablets cost about 3 cents each, and a 10 mg escitalopram tablet cost 3.9 cents.

The outlier was duloxetine. A 60 mg delayed-release capsule cost pharmacies 13.6 cents, roughly four times the others, and it was the only one of the six whose price rose over the past year, up 43 percent from October 2025.

All six are long-established antidepressants, yet their price records since 2013 have little in common. GxRadar analyzed CMS NADAC files from November 2013 through October 2026 and set them against FDA approval records. Three were already cheap when the federal series began and stayed cheap. Two went generic late and fell steeply. One got more expensive and has not gone back.

Six price histories in one table

Each figure below is GxRadar's monthly median of the weekly NADAC per-unit rate for generic-classified products of that drug and strength, drawn from the yearly datasets on data.medicaid.gov, starting with the 2013 file². The duloxetine series begins in February 2014, the first month a generic 60 mg capsule carried a generic rate. Full monthly series are on each drug's GxRadar page.

Source: GxRadar analysis of CMS NADAC weekly files, November 2013 to October 2026. Change compares October 2026 with the first month shown. Not adjusted for inflation.

Multiplied out, 30 units at the October 2026 rate came to $1.04 for sertraline, $1.18 for escitalopram, 90 cents for citalopram, 88 cents for fluoxetine, 91 cents for trazodone and $4.08 for duloxetine. Those are ingredient costs only. They say nothing about how any one person takes a medicine, and they leave out the dispensing fee and the markups that shape what a patient is charged, which our explainer on how pharmacies get paid walks through.

When the generics arrived

That split tracks the calendar of generic entry. GxRadar counted approved abbreviated new drug applications (ANDAs) for each exact strength and dosage form in FDA's Drugs@FDA data, queried through openFDA⁸, leaving out tentative approvals. "Still marketed" means FDA lists that strength with a prescription marketing status rather than as discontinued.

Source: GxRadar count from FDA Drugs@FDA via openFDA, downloaded November 2026.

Four of the six had at least seven years of generic competition behind them by November 2013, and their prices had little room left to fall. FDA economists found in a 2019 analysis¹⁰ that with six or more generic makers (the pattern our explainer on why generic prices fall as competitors enter traces), generic prices ran more than 95 percent below the brand price before generic entry. Citalopram ended the period within 7 percent of where it started, and fluoxetine within 15 percent.

Escitalopram was still young as a generic in 2013. Its first ANDA for the 10 mg tablet was approved in March 2012, and nine more came on a single day that September, according to FDA's Drugs@FDA records for escitalopram oxalate⁸. The NADAC figure actually rose for a year after our series began, peaking at 16.0 cents in October 2014. It then fell by 22 percent in September 2015 alone, jumped 31 percent in April 2016, and has drifted down since.

Duloxetine's fall, and its 2026 climb

Duloxetine shows what late generic entry looks like in the federal data. Six ANDAs for the 60 mg capsule were approved on Dec. 11, 2013, per FDA's Drugs@FDA records for duloxetine hydrochloride⁸, and the price fell about 79 percent between February and November 2014. Our piece on how fast prices fell for rosuvastatin, duloxetine and tadalafil follows that first year month by month.

Since 2024, duloxetine has moved the other way. The NADAC figure bottomed at 8.8 cents in December 2024, rose to 11.6 cents in April 2025, eased to about 9.4 cents by the end of that year, then climbed from 9.6 cents in January 2026 to 13.6 cents in October, according to the 2026 files¹.

That climb overlaps with a long run of quality recalls. FDA's drug enforcement database⁹ holds 45 recall records for duloxetine products, dated from May 2024 through July 2026, that cite the nitrosamine impurity N-nitroso-duloxetine. All 45 were Class II. Our explainer on nitrosamine impurities covers why FDA set limits on these compounds. NADAC records invoice prices without the reasons behind them, so the data cannot show whether the recalls moved the price. The GxRadar recall tracker lists the underlying records.

Trazodone, the one that rose

Trazodone is the oldest drug here and the cheapest in 2013, at 2.3 cents a tablet. In the autumn of 2015 its NADAC figure rose 44 percent in October and another 35 percent in November, according to the 2015 files³. It peaked at 5.9 cents in April 2016, more than two and a half times its 2013 level.

It has fallen most years since, but at 3.0 cents in October 2026 it was still about a third above where it started. Trazodone is one of a handful of drugs in our 47-drug basket that cost pharmacies more than they did in 2014, a group we list in the generics that got more expensive. The timing fits the wider wave of generic price spikes from 2013 to 2015, but the NADAC files do not say why a price moved.

Sertraline had its own brief jolt. In August 2020 its monthly figure jumped 55 percent, from 4.4 cents to 6.8 cents, in the 2020 files⁴. By October it was back to 4.6 cents.

The 2024 dip in every series

One pattern runs through all six lines. Each dropped sharply in the spring and early summer of 2024, rebounded, dropped again in November and December, and then climbed back in early 2025. Sertraline, escitalopram, citalopram and duloxetine all reached their lowest monthly figure of the entire series in December 2024, according to the 2024 NADAC files⁵.

Those swings were not specific to antidepressants, as our account of the 2024 NADAC swings shows. CMS said they came from "fluctuations in survey participation" and, starting with rates effective Dec. 18, 2024, began calculating monthly generic NADAC rates as a three-month moving average, according to the agency's NADAC page⁷ and its December 2024 methodology⁶. The same pattern runs through the GxRadar generic price index as a whole. Figures from 2025 onward are smoother by design.

CMS says the moving average will continue "until further notice" and that it plans to seek stakeholder input on a more permanent fix. Any change to that method would show up in all six series at once. GxRadar's price pages update as each weekly file is published.