Low dose naltrexone, usually written LDN, is the same molecule as the 50 mg addiction-medicine tablet at roughly a tenth of the strength. It is prescribed off-label at 1.5 mg to 4.5 mg for fibromyalgia, chronic pain and a range of autoimmune conditions. This page is about what it costs and why, not about whether it works or whether you should take it. That is a conversation for you and a clinician.
The reason LDN has its own price story is simple: no manufacturer makes it. FDA’s national drug code directory lists 45 marketed naltrexone tablet products and every single one is the 50 mg strength, plus one extended-release combination tablet where naltrexone is paired with bupropion. Nothing exists commercially at 4.5 mg. So an LDN prescription has to be compounded, which means a licensed pharmacy makes it to order, and you are paying for that labor rather than for the drug. All figures below were researched on September 3, 2026. If you are pricing the standard 50 mg tablet for alcohol use disorder or opioid use disorder instead, that is the cheaper, insurance-covered product and it lives on our naltrexone cost guide.
What Does Low Dose Naltrexone Cost Without Insurance?
Prices below are cash prices published by the pharmacies and services themselves, read September 3, 2026, except the two rows attributed to the American Fibromyalgia Syndrome Association, whose LDN pharmacy directory was last updated May 28, 2026. Acquisition cost is a CMS National Average Drug Acquisition Cost row effective August 19, 2026.
| Product and fill | Low | Average | High |
|---|---|---|---|
| LDN scored tablets, 90 tablets, 0.5 mg to 4.5 mg | $51.95 (CareFirst via AFSA) | $55.90 (with $3.95 shipping) | $63.95 (6 mg strength) |
| LDN four-scored tablets, 90 tablets | $65.00 (Avrio via AFSA) | $73.00 (with $8 shipping) | $80.00 (6 mg strength) |
| LDN sublingual tablets, compounded, per fill | $42.92 (CareFirst, as low as) | $42.92 (CareFirst) | $42.92 (CareFirst) |
| LDN capsules, compounded, per fill | $66.95 (CareFirst, as low as) | $66.95 (CareFirst) | $66.95 (CareFirst) |
| LDN capsules, flat per-capsule rate | $1.60 per capsule (Valor) | $48.00 per 30 capsules | $75.00 minimum order (Valor) |
| Telehealth subscription including the evaluation | $25/month (AgelessRx) | $25/month (AgelessRx) | $25/month (AgelessRx) |
| Naltrexone 50 mg tablet, what a pharmacy pays, per tablet | $1.13919 (NADAC) | $1.13919 (NADAC) | $1.13919 (NADAC) |
| Active ingredient in one 4.5 mg dose, at NADAC | about $0.10 (derived) | about $0.10 (derived) | about $0.10 (derived) |
Rows carrying one figure in all three columns have only one published price for that exact configuration. The last two rows are the point of the whole table: the naltrexone in a month of LDN costs roughly $3 at federal acquisition prices, and everything else you pay is compounding.
Sources disagree on what CareFirst charges, and the disagreement is instructive. AFSA’s directory quotes CareFirst scored tablets at $51.95 for 90 in any strength from 0.5 mg to 4.5 mg, while the pharmacy’s own product pages list compounded LDN sublingual tablets “as low as $42.92” and compounded LDN capsules “as low as $66.95.” These are different dosage forms with different labor, and CareFirst’s pages state outright that prices are subject to change and to call for a current quote. AFSA’s own page also contradicts itself slightly, describing CareFirst’s rate as 64 cents a tablet while quoting $51.95 for 90, which is 58 cents. Treat every LDN price you see online as a starting point for a phone call.
What Drives the Price
Compounding labor, not the molecule
Naltrexone is cheap. CMS acquisition data effective August 19, 2026 prices the 50 mg tablet at $1.13919, which puts the active ingredient in a 4.5 mg dose at about a dime and a 30-day supply of raw drug at roughly $3. What you are buying at $17 to $48 a month is a pharmacist weighing bulk powder, blending it with a filler, and filling capsules or pressing tablets. FDA’s own drug code directory shows this supply chain plainly: alongside the finished 50 mg tablets, it lists dozens of naltrexone powder entries registered specifically as bulk ingredient for human prescription compounding.
Dosage form
Capsules, scored tablets, four-scored tablets and sublingual tablets all cost different amounts to make, and the pricing follows. At CareFirst, the sublingual tablet starts at $42.92 while the capsule starts at $66.95. AFSA notes that most local compounding pharmacies offer LDN only as capsules, while a few mail-order compounders press scored tablets, which are cheaper per dose and let one prescription cover several strengths.
Quantity and minimum orders
Buying 90 at a time is materially cheaper than buying 30, and some pharmacies enforce that structurally. Valor Compounding publishes a flat rate of $1.60 per capsule with a $75 minimum order, which means a 30-capsule prescription costs $48 in drug but still triggers the $75 floor. At 90 capsules you clear the minimum and pay $144, which is the same $1.60 a day. Shipping is its own line: $3.95 at CareFirst and $8.00 at Avrio, per the AFSA directory.
Whether the pharmacy can ship to your state
Compounding pharmacies are licensed state by state, and that geography directly limits your ability to shop on price. AFSA notes that CareFirst ships to all 50 states plus the Virgin Islands, while Avrio is not licensed in 13 of them. If the cheapest pharmacy cannot ship to you, its price is not actually available to you.
The prescriber visit
LDN requires a prescription, and because the use is off-label, not every clinician writes it. That pushes a lot of people toward telehealth services, which price the visit into a subscription. AgelessRx lists LDN starting at $25 a month with monthly, three-month and six-month plans, free shipping, and HSA/FSA eligibility, and its terms state the prescription follows an online evaluation with a licensed medical professional. If you already have a prescriber willing to write it, you can skip that layer entirely and pay only the pharmacy.
Cash Price vs. Insurance
For LDN, there is usually no insurance question to answer. Compounded drugs are not FDA-approved, and FDA states directly that it does not verify the safety, effectiveness or quality of compounded drugs before they are marketed. Plans generally will not pay for a preparation that has no FDA approval and no national drug code of its own, and where the underlying use is off-label besides.
That has one clarifying effect on your shopping: since nearly everyone pays cash, the published cash price is the real price. There is no negotiated rate hiding behind it and no copay tier to hope for. It also means there is no manufacturer savings card, because there is no manufacturer.
Two things do help. HSA and FSA funds can generally be used for a compounded prescription with a valid prescription behind it, which effectively discounts the cost by your marginal tax rate. And because you are paying cash anyway, you are free to move your prescription to whichever licensed pharmacy quotes you the best number, which is not true of most drugs.
Discount cards are the exception that trips people up. Pharmacy discount cards work by repricing claims for products with a national drug code, so they generally do nothing for a compounded preparation. Our GoodRx vs. SingleCare comparison explains the mechanics, and the short version is that those cards are worth checking for the 50 mg tablet and not worth expecting anything from here.
How to Pay Less
Call three compounding pharmacies and ask for a written quote. The published spread between $42.92 and $66.95 is at a single pharmacy, across two dosage forms. Across pharmacies the spread is wider. Every LDN price page we read carries some version of “prices are subject to change, contact us for current pricing,” which is an invitation to ask.
Ask what a 90-day supply costs before you fill 30. At CareFirst’s scored-tablet rate of $51.95 for 90, a month costs $17.32. At Valor’s $1.60 flat rate you would pay $48 for 30 capsules and hit a $75 minimum order anyway, so the 90-count at $144 is the only fill that makes the per-day price honest. Ordering three months at a time also means paying shipping once instead of three times.
Ask specifically about scored or four-scored tablets. They are usually cheaper per dose than capsules, and one prescription covers a range of doses because you can break the tablet along the scoring, which matters if your prescriber adjusts your dose. Avrio’s four-scored tablets are $65.00 for 90 at 4.5 mg per the AFSA directory, allowing quarter-tablet increments from a single script.
Compare bundled telehealth against paying for a visit and a pharmacy separately. AgelessRx at $25 a month includes the evaluation and shipping. If you would otherwise pay a few hundred dollars for an office visit plus $40 to $70 for the compounding, the bundle wins in the first month. If you already have a prescriber, it usually does not. Our fair price checker shows typical cash visit prices so you can run that comparison against real numbers.
If the visit is the expensive part, price a sliding-scale clinic. Federally qualified health centers and community clinics set fees by income, and for a chronic condition you will be seen more than once. Our guide to free clinics and sliding-scale care covers how to find one near you.
If a bill already arrived and looks wrong, push back on it. Compounding pharmacies bill you directly, so mistakes are usually visible and fixable with a phone call. Clinic and specialist bills are the ones worth scrutinizing. Our guide to negotiating medical bills walks through requesting the self-pay rate and getting the adjustment in writing.
The Bottom Line
Compounded low dose naltrexone runs about $17 to $48 a month in September 2026, plus a prescriber visit, and virtually all of that is pharmacy labor rather than medicine. The drug itself costs about $3 a month at federal acquisition prices. That is why the same active ingredient can cost $22.94 for a month of 50 mg tablets and two to three times that for a month of 4.5 mg capsules.
Because insurance is almost never in play, the numbers you find by calling pharmacies are the numbers you will pay, and the range across pharmacies is wide enough to be worth an afternoon. If you are pricing the standard-dose product for alcohol or opioid use disorder rather than the compounded off-label version, start with our naltrexone cost guide, and if you are pricing the monthly injection of the same molecule, see Vivitrol. For the broader cost of managing a chronic pain condition without insurance, our guides to gabapentin and physical therapy cover the other line items people are usually pricing at the same time.