What pharmacies pay for seven blood pressure generics, 2014 and 2026

In October 2014, a retail pharmacy paid an average of $3.36 for one generic 160 mg valsartan tablet, according to the National Average Drug Acquisition Cost survey¹ that the Centers for Medicare & Medicaid Services runs for Medicaid. In October 2026, the latest NADAC files⁶ put the same tablet at 10.6 cents.

Valsartan is the extreme case. Six other blood pressure generics that pharmacies fill every day were already cheap in 2014, and most got cheaper. Taken together, 365 tablets of each of the seven drugs cost a pharmacy about $1,403 in ingredient cost at October 2014 rates and about $95 at October 2026 rates.

GxRadar compared NADAC figures for lisinopril, losartan, amlodipine, hydrochlorothiazide, metoprolol succinate ER, valsartan and carvedilol across those 12 years. The numbers show where the savings came from, how two rounds of recalls pushed prices up for a time, and why, for most of these tablets, the drug itself is now the smallest part of what a pharmacy is paid to fill a prescription.

Seven tablets, twelve years apart

Each figure below is GxRadar's monthly median of the weekly NADAC per-tablet rate for generic rows of one common strength, drawn from the yearly NADAC datasets on data.medicaid.gov. The last two columns multiply the rate by 365, a unit for comparison; how many tablets a person uses depends on the prescription. Each drug name links to its full monthly series on GxRadar.

Valsartan accounts for $1,186 of the $1,308 drop. Leave it out and the other six fell from $178 to $57, a decline of about two thirds.

NADAC is an ingredient cost and nothing more. CMS builds it from invoices that a sample of retail community pharmacies submit, and its December 2024 methodology⁷ says discounts or rebates not shown on the invoice line are left out. It is also a national average. It says little about what any one pharmacy paid, and nothing about what a patient pays at the counter, which depends on insurance, cash prices and plan rules. Our explainer on what NADAC measures covers those gaps.

Valsartan's first-generic premium

The 2014 valsartan figure is high for a specific reason. FDA's approval records, downloaded through openFDA⁹, show the first abbreviated new drug application for single-ingredient valsartan approved on June 26, 2014. Generic valsartan first appears in the 2014 NADAC files¹ in September of that year at $3.36 a tablet, a price set in the first months of generic sales.

It held above $3.18 through February 2015. The 2015 NADAC files² show the monthly figure at $2.16 in March, $1.00 in April, 46 cents in May and 37 cents by October. That timing fits the 180-day exclusivity period federal law can give a first generic filer, after which other approved makers can launch.

FDA has measured this pattern across many drugs. In a 2019 analysis¹¹ of products that first went generic between 2015 and 2017, the agency found that with one generic maker, the generic's average manufacturer price ran 39 percent below the brand's pre-generic price; with six or more makers, prices were more than 95 percent lower. GxRadar's count of the openFDA records finds 24 approved valsartan ANDAs, 18 of them with a product still listed as marketed. Our piece on why prices fall as competitors enter walks through the mechanics.

Two recalls and a slow return to normal

Those endpoints hide a detour. On July 13, 2018, FDA announced a voluntary recall⁸ of several medicines containing valsartan after an impurity, NDMA, was detected. In the 2018 NADAC files³, valsartan's monthly figure was 9.5 cents in July, 30.7 cents in October and 37.0 cents in December, nearly four times its pre-recall level.

Losartan followed the next year. FDA's running list of ARB recall updates⁸ records a series of losartan lot recalls through 2019, and on March 20, 2019, the agency said it would not object to certain makers temporarily distributing losartan containing the impurity NMBA above the interim limit, to keep the drug available. Losartan's NADAC rose from 3.3 cents in January 2019, per the 2019 files⁴, to 12.3 cents in September 2020, per the 2020 files⁵.

Neither spike lasted. Valsartan was still near 30 cents through mid-2021 but has since come back to 10.6 cents, close to its pre-recall 9.5 cents, and losartan was back to 3.3 cents in October 2026. Our articles on the valsartan recall and prices and on nitrosamine impurities trace both episodes, and the recall tracker has the underlying FDA records.

The cheapest tablets barely moved

Lisinopril, hydrochlorothiazide, amlodipine and carvedilol started the period at two to four cents a tablet. There was not much room to fall. Lisinopril's monthly figure has stayed between 1.56 cents and 2.35 cents for the entire series, and carvedilol ended October 2026 only 10.6 percent below where it stood in October 2014.

Metoprolol succinate ER is the clearest case of steady decline. It cost a pharmacy 33.2 cents a tablet in October 2014 and 5.0 cents in October 2026, and its figure fell 20.5 percent in the last 12 months alone. Valsartan dropped 27.6 percent over that period, while losartan and carvedilol ticked up by about 3 to 4 percent, small moves in fractions of a cent.

Low prices come with a known risk, which our long-deflation analysis discusses. Makers exit products that no longer pay. FDA's shortage data, available through openFDA¹⁰, include "to be discontinued" notices posted Nov. 19, 2025, and Aug. 31, 2026, in which a manufacturer reported a business decision to stop making a version of valsartan tablets and of metoprolol succinate ER tablets. A notice like that concerns one company's product. As of Oct. 30, 2026, FDA's list held 69 current shortages and 161 to-be-discontinued entries, which our shortage tracker follows.

Where the pharmacy's money goes

At October 2026 rates, 30 amlodipine tablets cost a pharmacy about 31 cents and 30 lisinopril tablets about 54 cents. Medicaid programs pay a separate professional dispensing fee on top of ingredient cost, and in CMS's state-by-state reimbursement table¹² for the quarter ending September 2026, the standard fee is $10.64 in Alabama, $10.18 in New York and $10.92 in New Jersey. For a 30-tablet fill of five of the seven drugs, the fee is roughly 10 to 36 times the ingredient cost.

Medicare drug plans and commercial plans negotiate their own fees with pharmacies, a separate system covered in our explainer on how pharmacies get paid. It is one reason the ingredient numbers in this piece can look tiny next to a cash price or copay; our guide to cash prices and copays explains how those are set, and the price pages carry all 47 drugs we track.

One methodological change also sits under the recent figures. Starting with the December 2024 updates, CMS calculates monthly generic NADAC rates as a three-month moving average, which its methodology⁷ calls a temporary, short-term measure prompted by swings in survey participation. Recent months are smoother by construction, and if CMS ends the measure, month-to-month moves in these tablets could get noisier again.