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Animal Research, Antitrust, Bioethics, Doctor-Patient Relationship, Enhancement, FDA, Health Care Finance, Health Care Reform, Health Law Policy, Intellectual Property, Jonathan Darrow, Market Design, Public Health, Reimbursement, Resource Allocation An earlier post discussed the equivocal efficacy of Propecia (finasteride) as a baldness remedy, ending with the provocative assertion that, efficacy aside, “there is little reason for anyone ever to buy or consume Propecia (finasteride), or any doctor ever to prescribe it, since a much cheaper and identical chemical sold under the trade name Proscar (finasteride), is available.” This post continues the discussion, addressing one small component of the rising cost of healthcare—the cost of finasteride. It explores why consumers pay as much as $240 for a bottle of Propecia (finasteride) when a $9 bottle of an equivalent, FDA-approved supply of the identical chemical is readily and legally available at nearby stores. In the exorbitantly priced landscape of prescription drugs, there is at least one low-cost oasis: Wal*Mart. Though some find reason to criticize the discount store, few would disapprove of the dozens of prescription medications Wal*Mart offers for an unbeatable $4 for a 30-day supply. Cost-sensitive consumers can purchase everything from blood thinners to antidepressants to antibiotics at this price, while a 90-day supply is only $10 (and this price shipping to your doorstep). A handful of drugs that cannot be sold at $4 per month sell for a still-modest $9. One of the drugs on Wal*Mart’s list is finasteride, used to treat androgenetic alopecia (male pattern hair loss), which can be obtained for a bargain price of $9 at Wal*Mart (or at Target, which has a nearly identical program). For the 300 or so drugs on Wal*Mart’s list, this means there is no longer a need for $10 co-pays or snowy treks to the pharmacy in 15 degree weather. However, patients in one major health care system (which will be referred to as “Big HMO”) will not have access to the Wal*Mart price, and may have to pay up to $240 dollars for an equivalent supply. Finasteride prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH). Finasteride is used to treat male pattern hair loss in men. It is also used to treat symptoms of benign prostatic hyperplasia (BPH) in men with an enlarged prostate. Finasteride may also be used for purposes not listed in this medication guide. This medicine should never be taken by a woman or a child. Finasteride can be absorbed through the skin, and women or children should not be permitted to handle finasteride tablets. Using finasteride may increase your risk of developing prostate cancer. 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