Why is Zovirax (acyclovir) cream more expensive than the tablets? How can patients cut costs?

Answered by Rebecca Farley | Reviewed by a licensed U.S. pharmacist | Posted July 28, 2020

Acyclovir, brand name Zovirax, treats skin conditions caused by herpesvirus. Whether taken via a tablet or the cream, the drug works by preventing the spread of the virus throughout your body. Generic acyclovir tablets have an average cost of $1.40 per tablet at a local U.S. pharmacy. With the U.S. Prescription Discount Card, the tablet can cost as little as $0.22 per tablet.

The real price headache here is the cream: Zovirax cream costs around $1,000 for a week’s worth of relief. And the generic cream cost isn’t doing us any favors. Five grams of Acyclovir (generic Zovirax) cream sells for an average of $839.65. The lowest-priced acyclovir cream will be found at an international pharmacy -- in the generic form. A 5g tube of the cream is 98% cheaper when ordered from an international online pharmacy than it would be at a U.S. local pharmacy.

Compare Acyclovir Tablet Prices

Compare Zovirax Tablet Prices

Compare Acyclovir Cream Prices

Compare Zovirax Cream Prices

There is one more formulation of acyclovir, which the FDA approved in 2014: Xerese. Xerese is an ointment composed of acyclovir and hydrocortisone used to treat herpesvirus. As it is newer, and does not have a generic alternative, Xerese is the most expensive formulation of acyclovir. Xerese sells for an average U.S. retail price of $1,438 for just five grams of the stuff. Abroad, the same amount of Xerese sells for closer to $50, a 96% drop from its exorbitant U.S. price.

Comparing Zovirax (acyclovir) Prices

Drug Strength Quantity U.S. Average Retail Price U.S. Prescription Discount Card Price Lowest PharmacyChecker-accredited International Pharmacy Price Greatest Percentage Discount
Zovirax (acyclovir) 400mg 30 tablets $332.65 N/A $22.18 93%
Acyclovir (generic) 400mg 30 tablets $42.81 $6.82 $12.28 84%
Zovirax Cream (acyclovir cream) 5% 5g $1006.42 $804.60 $132.97 87%
Acyclovir Cream (generic) 5% 5g $839.65 $327.39 $18.59 98%
Xerese (acyclovir and hydrocortisone) 5%/1% 5g $1,438 N/A $52.33 96%

Sources: Average U.S. Retail Price calculated based on pricing on GoodRx.com. PharmacyChecker U.S. Discount Card Price based on availability at pharmacies near New Orleans, Louisiana. Lowest Accredited International Pharmacy Price based on prices listed on PharmacyChecker.com.

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Why is Zovirax (acyclovir) cream so much more expensive than the tablets?

Even though Zovirax has been on the market since 1997 and U.S. pharmacies sell the generic formulation, the cream is still far more expensive than acyclovir tablets. This price difference may seem bizarre, as drugs with generic alternatives usually see dramatic price drops. In this case, the U.S. marketplace still does not have enough competition to bring down the price substantially. Perrigo, the Irish company that manufactures the generic acyclovir cream, only just earned FDA approval for the product in 2019.

As demonstrated in a PharmacyChecker white paper, new FDA-approved generic drugs are often not much cheaper than their brand counterparts. A drug usually needs up to five generic competitors before it sees a dramatic price decrease -- one that would truly make a difference for consumers -- per the FDA. In the case of Zovirax, the cream is but a year old, and only one pharmaceutical company manufactures it.

Read: Newly Approved Generics: Cost and Lack of Availability in the United States

Related: Why are drug prices so high in the U.S.?

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What are some common acyclovir side effects?

Common side effects of oral acyclovir include:

  • Headache

  • Nausea

  • Vomiting

  • Diarrhea

  • Dizziness

Common side effects of topical acyclovir include:

  • Flaking or dryness of treated area

  • Tingling, burning or itching sensation of treated area

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Can I get an over-the-counter treatment for herpesvirus?

Yes. Abreva (docosanol) is the only FDA-approved OTC treatment for cold sores associated with herpesvirus. The FDA approved it in 2000. Abreva exclusively treats cold sores on the lips; you cannot use it to treat cold sores in the genital area.

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Pharmacist TIP: Abreva works best if used initially when starting to develop a cold sore. When you apply it, you may feel a tingling sensation. That means the medication is working!

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Are there any other approved prescription treatments for herpesvirus?

Valacyclovir (brand name: Valtrex) can be used to treat herpesvirus, as well as famciclovir (brand name: Famvir). The FDA approved Famvir in 1994, and it does have a generic alternative with an attractive price tag: at international pharmacies, famciclovir sells for about $0.73 per tablet. Valtrex earned its approval just a year later, in 1995. It also has a generic, which sells for about $0.38 per tablet at international pharmacies.

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Where is Zovirax (acyclovir) manufactured?

Generic acyclovir tablets sold in the U.S. are manufactured in India, according to packaging. Zovirax tablets sold in the U.S. are manufactured in Canada. Zovirax cream sold in U.S. pharmacies is also manufactured in Canada.

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