Why Is Nitazoxanide So Expensive? The Economics of a $0.10 Pill
If you have ever filled a prescription for Nitazoxanide (brand name Alinia) in the United States, you likely experienced sticker shock. A standard three-day course can cost hundreds of dollars—sometimes exceeding $400 even for the generic version—while the brand-name listing price can soar into the thousands.
This pricing becomes even more baffling when you look internationally. In countries like India, Pakistan, or across South America, the same course of medication can be purchased for less than $10.00. Furthermore, researchers estimate the actual cost to manufacture the drug is mere pennies per pill.
So, why the massive disparity? The high cost of Nitazoxanide in the U.S. is not due to expensive ingredients or complex manufacturing; it is the result of a “perfect storm” of niche market dynamics, limited competition, and the unique structure of the American pharmaceutical system.
1. The “Niche Drug” Problem
Nitazoxanide is primarily approved to treat Cryptosporidium and Giardia, two intestinal parasites that cause diarrhea. While these infections are unpleasant, they are relatively rare in the U.S. compared to chronic conditions like high blood pressure or diabetes.
This places Nitazoxanide in a “niche” category. Blockbuster drugs (like statins or antidepressants) are manufactured in massive quantities, allowing economies of scale to drive the price down to pennies. Nitazoxanide is produced in much smaller batches. When prescription volume is low, manufacturers keep profit margins high on every individual unit to justify the logistical cost of keeping the drug in production and distribution.
2. The Illusion of Generic Competition
Usually, when a drug’s patent expires, multiple generic manufacturers rush in, driving the price down by 80-90% through fierce competition. While the primary patents for Alinia have expired, the market hasn’t been flooded with competitors.
Because the drug is low-volume (niche), it doesn’t attract dozens of generic manufacturers. Instead, the market sees only a small handful of players—sometimes just one or two at a time. In 2021, an “authorized generic” was launched, and other limited generics have followed (such as the 2025 launch by ANI Pharmaceuticals).
However, when only two or three companies make a drug, they form an oligopoly. They have no incentive to slash prices to rock-bottom levels because there is no swarm of competitors forcing them to do so. They can comfortably settle on a price that is lower than the brand name but still vastly higher than the cost of production.
3. The “Authorized Generic” Loophole
A significant factor in the pricing history of Nitazoxanide is the use of “authorized generics.” This occurs when the brand-name manufacturer (in this case, Romark) licenses a generic company to sell the exact same drug under a generic label.
While this sounds good, it often discourages independent generic companies from entering the market early. The brand owner effectively competes with itself to capture the “generic” market share, maintaining control over pricing longer than they would in a truly open market. This keeps the price floor artificially high.
4. US Pricing vs. Manufacturing Cost
The most frustrating element for consumers is the disconnect between the drug’s value and its production cost.
- Manufacturing Cost: Studies have estimated that the active pharmaceutical ingredients (API) needed for a full course of Nitazoxanide cost approximately $1.41 to produce.
- Retail Price: The U.S. pharmacy price is often 300 to 400 times higher than the production cost.
In many other nations, governments negotiate drug prices or cap profits on essential medicines, forcing the price closer to the manufacturing cost. The U.S. does not utilize these caps, allowing manufacturers to price drugs based on “what the market will bear.” For a drug that treats an acute, miserable infection, the market will bear a high price because patients need immediate relief. Buy Now: https://www.grantpharmacy.com/nitazoxanide
