Why Cost Matters for Locoid Adherence

When patients can't afford their medication, they don't take it. This isn't a surprise to any practicing clinician, but the specifics matter: a 2024 KFF survey found that nearly 30% of adults reported not filling a prescription due to cost, and dermatology medications are frequent offenders. Locoid (Hydrocortisone Butyrate 0.1%) is a mid-potency topical corticosteroid that's clinically effective for atopic dermatitis, contact dermatitis, and other corticosteroid-responsive dermatoses — but brand-name pricing of $150 to $400 per tube can stop patients from ever filling their prescription.

This guide is for dermatologists, primary care physicians, pediatricians, and other prescribers who want practical, actionable strategies to help patients access Locoid at a price they can actually pay.

What Patients Are Paying

Understanding the cost landscape helps you set expectations and guide patients effectively.

Brand-Name Locoid

• Cash price: $150–$400 depending on formulation (cream, ointment, lipocream, solution) and quantity
• Locoid Lipocream tends to be at the higher end due to limited generic competition for this specific formulation
• Insurance coverage: Varies widely. Many plans require prior authorization or step therapy for brand-name Locoid. Some formularies exclude it entirely in favor of generic alternatives

Generic Hydrocortisone Butyrate

• Cash price: $30–$80 for a 15-45g tube (cream or ointment)
• Insurance: Most plans cover generic Hydrocortisone Butyrate at Tier 2 or Tier 3 copays, typically $10–$40
• Availability: Generic cream and ointment are generally well-stocked. The lipocream formulation has less generic competition

The Price Gap

The difference between brand and generic can be $100 to $350 per fill. For patients paying cash or facing high-deductible plans, this gap is the difference between adherence and abandonment. When clinically appropriate, prescribing the generic by default is the single most impactful cost-saving measure you can take.

Manufacturer Savings Programs

Bausch Health (the manufacturer of Locoid) has periodically offered savings programs:

Copay Savings Cards

Bausch Health has offered copay cards for Locoid Lipocream that can reduce out-of-pocket costs for commercially insured patients. These programs typically:

• Reduce copays to $0–$35 per fill
• Are available to patients with commercial insurance (not Medicare, Medicaid, or other government programs)
• Have annual caps on savings
• May be discontinued or modified without notice

Check bauschhealth.com or contact a Bausch Health representative for current program availability. Consider having your office staff check periodically, as these programs change frequently.

Patient Assistance Program (PAP)

For uninsured or underinsured patients, the Bausch Health Patient Assistance Program may provide Locoid at no cost. Eligibility typically requires:

• No prescription drug coverage or inadequate coverage
• Income below a certain threshold (often 200-400% of the Federal Poverty Level)
• U.S. residency

Applications can be submitted through bauschhealth.com, or patients can be directed to NeedyMeds and RxAssist to find and apply for available programs.

Coupon and Discount Cards

Prescription discount programs can significantly reduce the cash price of generic Hydrocortisone Butyrate. These are especially useful for uninsured patients or those whose insurance copay exceeds the discounted cash price.

Major Discount Platforms

• GoodRx — Widely used; shows pricing at nearby pharmacies and provides free coupons. Generic Hydrocortisone Butyrate prices through GoodRx can be substantially lower than list price.
• SingleCare — Similar to GoodRx with competitive pricing at many chains
• RxSaver — Compares prices across pharmacies
• Optum Perks — Free discount card accepted at most major pharmacies
• BuzzRx — Another free discount option

How to Recommend Them

Patients often don't know these tools exist. A simple statement at the point of prescribing can make a real difference: "The generic version should be around $30-$80 at most pharmacies, but check GoodRx or SingleCare before you fill it — you might get it even cheaper."

Some practices print GoodRx coupons directly from the website and hand them to patients with their prescriptions. This takes seconds and can save patients significant money.

Generic Alternatives and Therapeutic Substitution

When Locoid specifically isn't necessary, therapeutic alternatives can offer similar efficacy at lower cost and better availability.

Direct Generic Substitution

Generic Hydrocortisone Butyrate 0.1% (cream, ointment, solution) is the simplest substitution. It contains the same active ingredient at the same concentration. Unless you write "dispense as written" or "DAW," the pharmacist can automatically substitute.

Clinical note: The one area where substitution is less straightforward is Locoid Lipocream. The lipocream vehicle is proprietary, and generic versions may use a different base that affects cosmetic feel and patient preference (though not necessarily efficacy). If a patient specifically needs the lipocream texture, discuss this with them.

Therapeutic Alternatives (Different Molecules)

If Hydrocortisone Butyrate is unavailable or cost-prohibitive even as a generic, consider these mid-potency alternatives:

• Triamcinolone Acetonide 0.1% — The workhorse of mid-potency topical steroids. Extremely affordable (often under $10 with discount cards), widely available, well-studied. This is the most common therapeutic substitution for Locoid.
• Betamethasone Valerate 0.1% — Another mid-potency option with good generic availability and low cost.

For patients who need a lower potency (sensitive areas, children):

• Desonide 0.05% — Low-potency, good safety profile for the face and skin folds. Generic is affordable.

For patients who need a step up in potency:

• Mometasone Furoate 0.1% — Mid-to-high potency with once-daily dosing. Generic available and reasonably priced.

For a detailed comparison of alternatives, see our clinical guide: Alternatives to Locoid.

Building Cost Conversations into Your Workflow

Cost transparency shouldn't be an afterthought. Here are practical ways to integrate it into your prescribing workflow:

At the Point of Prescribing

• Default to generic. Prescribe "Hydrocortisone Butyrate 0.1% cream" rather than "Locoid" unless there's a specific clinical reason for the brand.
• Mention cost proactively. Patients rarely volunteer that they can't afford a medication. A brief mention — "This generic should be reasonable, but let me know if cost is an issue" — opens the door.
• Know your formularies. If your EHR includes formulary checking, use it. If not, generic mid-potency steroids are nearly universally covered.

At Follow-Up

• Ask about adherence. If a patient isn't improving as expected, ask whether they've been using the medication as directed — and whether cost played a role in any gaps.
• Reassess the formulation. If a patient was started on brand-name Locoid Lipocream and cost is a barrier, switching to generic cream or ointment may solve the problem.

Office Resources

• Keep a list of discount card websites (GoodRx, SingleCare, RxSaver) posted in exam rooms or at checkout
• Train front-desk staff to mention these resources when handing out prescriptions
• Consider using Medfinder for Providers to help patients locate pharmacies with stock availability, reducing the frustration of unfilled prescriptions

For Your Uninsured Patients

Uninsured patients face the steepest prices. A layered approach works best:

1. Start with generic Triamcinolone 0.1% — often under $10 with a discount card, making it the most cost-effective mid-potency option
2. If Hydrocortisone Butyrate is specifically needed, use discount cards for the generic ($30-$80)
3. If brand Locoid is necessary, check for active manufacturer copay cards or patient assistance programs
4. For patients in financial hardship, refer to NeedyMeds, RxAssist, or the Bausch Health PAP

Final Thoughts

The clinical effectiveness of Locoid is well-established — but a medication only works if patients can afford to fill it. By defaulting to generic prescribing, mentioning discount tools proactively, and knowing when to use therapeutic alternatives, you can keep your patients on effective treatment without the cost barrier.

For more provider-focused resources on Locoid availability and prescribing, see our guides on the Locoid shortage for providers and helping patients find Locoid in stock. And explore Medfinder for Providers to give your patients real-time pharmacy stock information.