OBJECTIVES: Despite concerns regarding bioequivalence of NB-CsA to B-CsA, generics constitute the second most widely used form of CsA in the US. We assessed whether potential cost savings associated with the lower acquisition cost of generics are realized with NB-CsA. METHODS: Claims data from eight commercial health plans were linked to Organ Procurement Transplant Network data. De novo kidney recipients with =1 pharmacy claim for B-CsA (n=247) or NB-CsA (n=64) were included. Information was collected for 1 year before and after initial (index) CsA claim. Patients who switched between study drugs or had <1 year pre- or post-index data were excluded. Log transform regression with backward selection was used to model costs in the first year post-index. Statistical significance of cohort differences in predicted costs was determined by bootstrapping with 1000 repetitions. RESULTS: Baseline demographics were similar between the two cohorts; 62% male, 60% age >45 years, and 10% African American. Total prescription medication costs were higher for NB vs. B-CsA ($14,233 vs. $12,606, p=0.04), reflecting higher costs for both immunosuppressant (IS) and non-IS drugs incurred by the NB-CsA cohort. NB-CsA patients had higher inpatient costs ($17,459 vs. $7,904), more hospitalizations (4.5 vs. 3.2, respectively), and slightly higher outpatient costs ($8,547 vs. $7,477) vs. B-CsA. Utilization for gastrointestinal symptoms (e.g., abdominal pain, vomiting, diarrhea) was higher in the NB vs. B-CsA cohort (13% vs. 5%, p=0.04) as were total healthcare costs ($40,239 vs. $27,988, p=0.07). After controlling for patient characteristics and pre-transplant costs, total costs were 27% higher (p=0.03) for NB vs. B-CsA. For the average patient taking NB vs. B-CsA, predicted costs were $8,291 higher (95% CI: $122, $21,278). CONCLUSION: Despite lower acquisition cost of generics, de novo renal transplant recipients initiated on NB-CsA incurred increased healthcare costs, which appeared to be driven by costly pharmacy and inpatient utilization.