Seven older generics that cost pharmacies more than in 2014

In October 2014, pharmacies paid about $1.18 for 30 generic allopurinol 100 mg tablets, according to the federal government's weekly drug cost survey¹. Two months later the same 30 tablets cost them $5.15. The gout drug, first approved in 1966, kept climbing to $5.80 in September 2015, the 2015 survey files² show, and then took the better part of a decade to drift back down.

It has not quite made it. In October 2026 the 30 tablets cost pharmacies 94 cents (3.1 cents a tablet), a nickel more than the 89 cents of January 2014, according to the 2026 files⁵. Allopurinol is one of seven drugs in GxRadar's 47-drug price basket that cost pharmacies more in October 2026 than in January 2014. The others are furosemide, warfarin, glipizide, trazodone, amoxicillin and cephalexin. The 36 other drugs with a 2014 price cost less, and the GxRadar generic price index stood at 47.4 (January 2014 = 100), about 53 percent below its starting point.

The seven share one trait that stands out in FDA's records, which is age. Their first approvals came between 1954 and 1984, and all have had generic copies for decades. This piece sets out what a typical fill of each cost pharmacies, when each increase happened, how many generic applications FDA lists for each strength, and what federal analyses say about how old, cheap drugs get more expensive. It does not assign a cause to any one drug's increase, because the public data do not show one. Our wider survey of basket drugs that rose also covers the five-year comparison.

What a fill cost in 2014 and in 2026

The figures are GxRadar's monthly medians of NADAC, the National Average Drug Acquisition Cost that CMS builds from a monthly survey of retail pharmacy invoices. They are acquisition costs, what pharmacies paid to buy the drug, and not what a customer pays at the counter. Each per-unit figure is multiplied by the drug's typical fill, the average quantity per prescription in Medicaid's 2025 State Drug Utilization Data⁶, rounded to a common count. Those fill sizes describe how prescriptions are commonly dispensed and say nothing about how anyone should take a drug. None of the figures is adjusted for inflation.

In dollars the increases are small. One fill of each of the seven cost pharmacies $11.34 in October 2026, $1.68 more than in January 2014. In percentage terms furosemide stands apart, at nearly three times its 2014 cost. Four of the seven (warfarin, glipizide, allopurinol and amoxicillin) are within 10 percent of their 2014 level, so they sit above the line only narrowly.

Three ways a price went up

The monthly series trace three different shapes, which is one reason no single explanation fits all seven.

A spike, then a long decline. Allopurinol, warfarin and trazodone each jumped within a few months and then fell for years. Warfarin 5 mg went from $2.44 for 30 tablets in July 2014 to $5.62 by December 2014 and peaked at $6.22 in April 2015. Trazodone 50 mg went from 70 cents in July 2015 to $1.76 by April 2016. All three have since given back most of the gain. Compared with October 2021, according to the 2021 NADAC files⁴, allopurinol is down 48 percent, trazodone 23 percent and warfarin 17 percent.

A step up that stuck. Furosemide had roughly doubled by mid-2017, from 31 cents for 30 tablets in January 2014 to 60 cents in August 2017. Between September and November 2017 it rose to $1.09, the 2017 files³ show. In every month since, the cost has stayed between 82 cents and $1.09. It was 87 cents in October 2026.

A slow climb. Cephalexin and amoxicillin, antibiotics with generic approvals on record since the mid-1970s, never spiked the way the others did. Cephalexin rose gradually from late 2020 and peaked at $2.96 for 20 capsules in December 2023. Amoxicillin peaked at $2.12 in March 2024, after the amoxicillin shortage of 2022 and 2023, and it is one of only three basket drugs, with simvastatin and citalopram, that cost more in October 2026 than five years earlier. Glipizide 5 mg has moved within a narrow band, from a low of $1.43 for 60 tablets in January 2018 to the $2.21 high of February 2022.

Old drugs, many applications, fewer still marketed

The dates and counts come from FDA's Drugs@FDA⁷ records, in the openFDA download⁸ updated Nov. 2, 2026, and include only applications that cover the basket strength. "Listed as marketed" means at least one product under the application carries a prescription marketing status rather than "discontinued." It does not show how much any maker ships. For the oldest drugs the ANDA count is also an incomplete roster: Drugs@FDA lists 10 new drug applications for furosemide 40 mg tablets approved between 1966 and 1994, three of them still marketed, alongside the eight ANDAs. Year-by-year totals for all generics are on our approvals page.

The counts do not split the risers from the fallers. Finasteride 5 mg, with eight marketed generic applications, costs pharmacies 61 percent less than in 2014, as our finasteride price history shows. Allopurinol 100 mg has 12 and still sits above its 2014 level. Drugs@FDA records approvals and marketing status. It does not record which firms are actually supplying a drug in a given month, or in what volume.

What federal analyses say about old generics getting pricier

FDA economists measured the link between competition and price in a December 2019 analysis⁹ of drugs that first faced generic entry from 2015 to 2017. With a single generic maker, the generic's average manufacturer price was 39 percent below the brand's pre-generic price. With four makers it was 79 percent lower, and with six or more, prices were more than 95 percent lower. That study looked at entry rather than exit, but it describes the price pressure that thins when makers leave. FDA keeps it and later savings estimates on its generic competition and drug prices page¹⁰, and our explainer on why prices fall as competitors enter walks through the curve.

The HHS Office of the Assistant Secretary for Planning and Evaluation reviewed the evidence in a January 2016 issue brief¹¹, written as reports of generic price spikes piled up. About two-thirds of generic products appeared to have had price declines in 2014, it found, and the spikes were confined to segments of the market. It listed the likely explanations as "small markets with limited entry; the impact of mergers, acquisitions, and market exits; the ability to obtain new market exclusivities; and distribution activities."

The HHS Office of Inspector General counted how often generic prices outran inflation. Its December 2015 audit¹² found that 22 percent of the quarterly average manufacturer prices it reviewed rose faster than the inflation factor applied to brand drugs. Had the brand inflation penalty applied, it estimated, Medicaid would have collected $1.4 billion more in rebates on the top 200 generics from 2005 through 2014. The Bipartisan Budget Act of 2015 extended that penalty to generics starting in 2017, as our piece on Medicaid rebates for generics explains.

Some of the earliest public warnings came at a Senate subcommittee hearing on Nov. 20, 2014¹³, titled "Why Are Some Generic Drugs Skyrocketing in Price?" Testimony in the hearing record listed one manufacturer's glipizide 5 mg tablets among products with very large increases in 2013, 94 percent in that case. Our account of the price spikes of 2013 to 2015 covers that period.

FDA's 2019 report on the root causes of drug shortages¹⁴ describes the pressure from the other direction. "Manufacturers of older generic drugs, in particular, face intense price competition, uncertain revenue streams, and high investment requirements, all of which limit potential returns," the agency's task force wrote, adding that contracting practices contribute to "a 'race to the bottom' in pricing." The drugs in its sample that went into shortage from 2013 to 2017 had a median of almost 35 years since first approval.

What FDA's shortage list shows for these drugs

None of the seven molecules has a tablet or capsule listed as a current shortage. Other forms of one of them are. GxRadar's copy of FDA's shortage data¹⁵, current to Nov. 3, 2026, lists furosemide injection as a current shortage since April 2020 and furosemide oral solution since March 2026. It also carries an allopurinol tablet entry, posted in February 2026, in the "to be discontinued" category, which records a manufacturer's notice that it is stopping some presentations. The full list is on our shortage tracker, and a separate explainer covers discontinuation entries.

What to watch

The next data point is the November monthly NADAC file, which CMS produces on the first Monday on or after the 15th of the month, according to its NADAC page¹⁶. Since December 2024, monthly generic rates have been a three-month moving average, which damps sudden moves, under the agency's current methodology¹⁷. Four of the seven sit within 10 percent of their 2014 cost, and allopurinol is 5 percent above it, so a modest decline in any of the four would take it off this list. The drug pages linked above update as the files do.