You can get acne medication through three main routes: buying over-the-counter products at any pharmacy, getting a prescription from your primary care doctor or dermatologist, or using a telehealth service online. The right path depends on how severe your acne is and what treatments you’ve already tried.
Over-the-Counter Options to Try First
Several effective acne-fighting ingredients are available without a prescription. For most people with mild breakouts, these are worth trying before making a doctor’s appointment.
Benzoyl peroxide kills acne-causing bacteria, removes excess oil, and clears dead skin cells from pores. It comes in strengths from 2.5% to 10%. Starting at a lower strength helps you gauge how your skin reacts before moving up.
Adapalene 0.1% gel (sold as Differin) is a retinoid that unclogs pores and prevents new breakouts. It used to require a prescription but is now available over the counter for anyone 12 and older. Some studies suggest that a higher-strength adapalene gel (0.3%, still prescription-only) works about as well as prescription tretinoin cream.
Salicylic acid (0.5% to 2%) helps unclog pores and comes in both leave-on and wash-off formulas. Azelaic acid at 10% strength prevents pore blockages and has mild antibacterial effects. Glycolic acid and lactic acid, both alpha hydroxy acids, are also found in many over-the-counter acne products.
Give any new product at least 6 to 8 weeks before deciding it isn’t working. Acne treatments need time, and switching too quickly makes it hard to tell what’s actually helping.
Getting a Prescription From Your Doctor
If over-the-counter products haven’t cleared your skin, or if your acne is moderate to severe, you’ll need a prescription. Both primary care doctors and dermatologists can prescribe acne medication, but there are meaningful differences in what you can expect from each.
Primary care doctors handle common acne cases regularly and can prescribe topical retinoids, oral antibiotics, and sometimes hormonal treatments. However, dermatology makes up only about 5% of their training content, so they may be less familiar with the nuances of choosing between different retinoid formulations or managing complex cases. A dermatologist is more likely to know, for example, that adapalene is significantly less irritating than tretinoin or tazarotene, and to match the right formulation to your skin type, sensitivity, and lifestyle.
For straightforward acne, your primary care doctor is a perfectly reasonable starting point and often has shorter wait times. If your acne hasn’t responded to initial treatments, involves scarring, or has a hormonal pattern, a dermatologist referral makes more sense.
Common Prescription Medications
Topical Retinoids
Tretinoin (commonly known as Retin-A) is the most widely prescribed topical retinoid for acne. It’s stronger than over-the-counter adapalene, and doctors typically start patients at 0.025% strength. Higher-strength versions and different formulations are available if your skin tolerates the starting dose well. Tretinoin requires a prescription at all concentrations.
Oral Antibiotics
For inflammatory acne with red, swollen bumps, your doctor may add an oral antibiotic. These reduce acne-causing bacteria on the skin and calm inflammation. The American Academy of Dermatology recommends antibiotics be prescribed for the shortest time possible, which typically means three to four months. Your doctor will usually pair the antibiotic with a topical treatment so you have something to continue using after you stop the antibiotic.
Hormonal Treatments for Women
Spironolactone is an option for women whose acne persists despite topical treatments. Research published in The BMJ found it can significantly reduce long-term antibiotic use for women with stubborn acne. Before starting, your doctor will check kidney function and potassium levels. Most prescribers start at 50 mg and increase to 100 mg within a week or two if it’s well tolerated. Spironolactone is not prescribed for men because it lowers testosterone levels and can cause breast swelling. Women taking it receive contraceptive counseling since it should be avoided during pregnancy.
Isotretinoin for Severe Acne
Isotretinoin (originally sold as Accutane) is reserved for severe, treatment-resistant acne. Getting it involves more steps than any other acne medication because of its potential to cause serious birth defects. All patients and prescribers must register with a federal program called iPLEDGE. Patients who can become pregnant need pregnancy tests before starting treatment, and their prescriptions must be picked up within a 7-day window. If that window is missed, a repeat pregnancy test is required, though recent FDA modifications have eliminated the additional waiting period that used to follow. Patients who cannot become pregnant still receive counseling at enrollment but no longer need monthly documentation. Isotretinoin is not given to children under 12 or before puberty.
Using Telehealth to Get a Prescription
Online dermatology services have made getting acne prescriptions considerably easier. The typical process involves submitting photos of your skin and a list of your symptoms through a website or app. A dermatologist reviews your case and responds with a treatment plan, usually within a few days. If a prescription is needed, it’s either sent to your local pharmacy or the medication ships to your door.
Costs vary quite a bit between platforms. Nurx charges $40 for a medical consultation (insurance doesn’t cover the consult but may cover the medications), with creams starting around $25 per month and oral medications around $15 per month. Teladoc dermatology visits cost as little as $0 with insurance or $95 without. Curology runs $30 to $35 per month as a subscription that includes prescription products. Hims and Hers starts at $10 per month for prescription products.
Telehealth works well for mild to moderate acne and for refilling existing prescriptions. It’s less ideal for severe acne that might need isotretinoin, since that requires in-person blood work and pregnancy testing through the iPLEDGE program.
What to Know About Insurance and Cost
Many acne medications, especially newer brand-name topicals, require prior authorization from your insurance company before they’ll be covered. This means your doctor’s office submits paperwork explaining why you need the medication. What triggers prior authorization varies widely between health plans, and even your dermatologist may not know your specific plan’s requirements until they submit the prescription.
When dermatology practices have tracked how long prior authorization takes, about half of patients received a response within 8 business days. If your medication is denied, your doctor can often appeal or switch to a covered alternative. Generic versions of tretinoin and oral antibiotics are typically covered with minimal hassle, while newer brand-name products are more likely to face hurdles.
If you don’t have insurance or your plan’s coverage is limited, ask your prescriber about generic alternatives. Generic tretinoin, generic doxycycline, and over-the-counter adapalene can form an effective regimen at a fraction of the cost of brand-name products. Telehealth subscriptions can also be more affordable than traditional office visits for people paying out of pocket.