A standard course of Alinia (nitazoxanide), just six tablets to treat a parasitic infection, carries a retail price of roughly $550 to $850 depending on the pharmacy. That’s staggering for a short course of an antiparasitic, especially when the most common alternative, metronidazole, costs about $21 for a much larger supply. Several factors stack on top of each other to keep the price this high.
A Small Market With Limited Competition
Alinia is FDA-approved to treat two specific conditions: diarrhea caused by Cryptosporidium and Giardia parasites. These infections are relatively uncommon in the United States, which means the total number of prescriptions written each year is small. Pharmaceutical companies price drugs partly based on how many people will buy them. When the patient population is narrow, the per-unit price goes up to recover development and manufacturing costs.
Romark Laboratories, the company behind Alinia, held a string of patents on nitazoxanide that didn’t fully expire until 2018. During that window, no competitor could legally produce a generic version. Even after the patents expired, generic entry was slow. The FDA didn’t approve the first generic nitazoxanide tablet until 2020, when Rising Pharma Holdings received approval. Rising was also granted a “competitive generic therapy” designation, which gave it 180 days of exclusivity before other generic manufacturers could enter the market.
In theory, generics should drive prices down dramatically. In practice, the effect has been modest here. The generic version still runs around $220 or more per course with a discount coupon. When only one or two generic manufacturers compete in a small market, there isn’t enough competitive pressure to push prices anywhere near the pennies-per-pill range you see with widely used generics like metronidazole.
Insurance Often Doesn’t Help Much
Even with insurance, Alinia can hit your wallet hard. Nitazoxanide typically lands on Tier 5 of insurance formularies, which is the highest cost-sharing tier. Tier 5 is reserved for specialty or high-cost drugs, meaning your copay or coinsurance percentage will be significantly larger than it would be for a Tier 1 or Tier 2 generic. On some plans, Tier 5 drugs require you to pay a percentage of the full cost rather than a flat copay, so you could still owe $100 or more out of pocket.
Some insurers also impose dispensing limits on nitazoxanide, restricting how many tablets you can fill at once. Prior authorization requirements vary by plan but aren’t universal. The practical result is that many patients end up paying a large share of the cost themselves, which is why the retail price feels so painful.
How It Compares to Alternatives
The price gap between Alinia and its main alternative is enormous. Metronidazole, the standard treatment for Giardia and many other infections, costs roughly $0.21 per tablet. Nitazoxanide costs closer to $37 per tablet at discount prices, and the full retail price can push past $90 per tablet. That’s a difference of several hundred dollars for treating the same infection.
Metronidazole works well for Giardia and is the first-line treatment most doctors reach for. Alinia occupies a narrower role. It’s the preferred option for Cryptosporidium in people with healthy immune systems, where metronidazole isn’t effective. It’s also sometimes used when a patient can’t tolerate metronidazole or when first-line treatment fails. Because Alinia fills a niche that other cheap drugs can’t always cover, there’s less market incentive to lower the price.
Ways to Reduce Your Cost
If you’ve been prescribed nitazoxanide, ask your pharmacist to fill the generic version rather than brand-name Alinia. The generic is bioequivalent, meaning it works the same way in your body. Using a pharmacy discount coupon from services like GoodRx can bring the price for six generic tablets down to around $220, compared to $550 or more at full retail.
It’s also worth asking your doctor whether metronidazole or tinidazole would be appropriate for your specific infection. If you have Giardia rather than Cryptosporidium, a cheaper alternative may work just as well. For patients who genuinely need nitazoxanide and can’t afford it, some pharmaceutical assistance programs help connect uninsured or underinsured patients with coverage options, though Romark itself does not widely advertise a dedicated patient assistance program for Alinia.
Shopping around between pharmacies can also make a difference. Prices for the same generic drug can vary by $100 or more depending on whether you fill at a chain pharmacy, an independent pharmacy, or a mail-order service. Checking prices at several locations before filling the prescription is one of the simplest ways to save.