$2.8 Million for One Treatment: These Are the Most Expensive Drugs in the U.S

$2.8 Million for One Treatment: These Are the Most Expensive Drugs in the U.S

From gene therapies to generics, many treatments in the U.S. carry an outrageous sticker price.

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Until recently, the gene therapy Zolgensma was the most expensive drug ever approved in the U.S.
Until recently, the gene therapy Zolgensma was the most expensive drug ever approved in the U.S.
Image: Shutterstock (Shutterstock)

The U.S. healthcare system is, to put it lightly, a complete trash fire. Compared to people living in other well-off countries, Americans are overall sicker and die at a younger age. Adding insult to injury, Americans also have to pay more for their health care, and a large part of that added cost comes from high-priced prescription drugs and other treatments.

In mid-August, President Biden signed the Inflation Relief Act into law, a major legislative package that includes several important reforms intended to curb high health care costs. These reforms are likely to be mostly modest in impact, however, and some won’t come into effect for several years, such as allowing Medicare to negotiate the cost of certain drugs starting in 2026. In the meantime, prices for newly launched drugs may reach a record high this year, if trends hold.

Many treatments are more expensive in the U.S. than elsewhere or are rising in price at levels much higher than inflation in general would dictate. But there are some especially costly drugs out there, so let’s go through a few of the worst offenders.

Some of these drugs have the highest list prices around, while others are at the top of their particular category, such as those that have become generic. Another important note is that patients often don’t pay for the entirety of their drugs, especially if they have private or public insurance or if they’re eligible for discount programs run by the drug’s manufacturers. But coverage plans don’t always foot the bill for people’s recommended treatments, and even when covered, high list prices have historically contributed to high out-of-pocket costs and constrain the resources of public payers like Medicare and Medicaid.

Drug companies are reluctant to share the list prices of their drugs. So many of the costs cited here come from several recent analyses by GoodRx, a company that tracks drug prices and also offers coupons on select drugs.

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Zynteglo

Zynteglo

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Zynteglo is a gene therapy intended for people with beta thalassemia, a rare inherited condition that results in lower production of hemoglobin and red blood cells, which help transport oxygen around the body. The treatment modifies blood cells so that they can produce functional beta-globin, a component of hemoglobin.

Approved by the FDA in August 2022, the single-dose treatment is expected to cost $2.8 million per patient—seemingly the highest price yet for an individual course of medication. If it works as intended, though, it would replace the lifelong blood transfusions and extended hospital stays that patients with beta thalassemia typically require.

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Tadalafil

Tadalafil

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Better known by the brand name Cialis, tadalafil is primarily prescribed to treat erectile dysfunction, with a longer window of effectiveness (36 hours) than other similar drugs such as Viagra. It can also be used to treat a certain form of high blood pressure and an enlarged prostate.

Though it’s been generic since 2018, the average cash price of a 30-day supply of tadalafil at the pharmacy is still currently around $518. That makes it the most expensive popular generic drug today, according to a recent report from GoodRx. There are reportedly plans to bring an over-the-counter version of it to shelves, which would be cheaper, but that may take years to happen.

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Humira

Humira

An autoinjector product containing adalimumab.
An autoinjector product containing adalimumab.
Photo: Raimond Spekking/Wikimedia Commons

Humira is an immunosuppressant that has proven to help treat a variety of immune-related conditions, such as Crohn’s disease, rheumatoid arthritis, and the most common form of psoriasis.

Despite its clear value, Humira has become a poster child for the drug cost problem at large. The drug’s maker, AbbVie, has viciously fought to keep the active ingredient in Humira (adalimumab) expensive after its original patents ended in 2016 through the filing of additional patents, lawsuits, and deals with generic manufacturers to delay their biosimilar versions from coming out. As a result, the company has continued to raise the price of Humira, and it costs around $72,000 a year. The price-gouging may finally start to die down in 2023, when a flood of biosimilars are expected to reach the market.

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Zokinvy

Zokinvy

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A monthly supply of Zokinvy can cost around $89,000 and upwards of $1 million for a year.

Taken as a pill, Zokinvy was approved in 2020 as the first specialized treatment for Hutchinson-Gilford progeria syndrome, a rare genetic condition that prematurely ages the body (most people with it die before age 15). It reduces the build-up of progerin, a defective protein that plays a key role in the condition. In trials, the drug extended people’s lives by an average 2.5 years.

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Enjaymo

Enjaymo

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Photo: Sanofi

Enjaymo is a lab-made antibody that helps prevent the destruction of red blood cells in people with a rare blood condition known as cold agglutinin disease.

Approved in February 2022, the annual cost of the drug is expected to be around $280,000, according to a report from Reuters. Enjaymo isn’t alone in its excessiveness either, as the median annual cost of newly launched drugs in 2022 so far is around $257,000.

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Kimmtrak

Kimmtrak

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Kimmtrak was approved in 2022 for advanced uveal melanoma, a form of eye cancer, as well as cases where the cancer isn’t able to be surgically removed. The first drug of its kind, it’s taken intravenously and is supposed to work by allowing immune cells to better target certain “cold” tumor cells that would otherwise go undetected.

While this class of drugs may have a bright future ahead, they won’t come cheap. A year’s supply of Kimmtrack will cost $975,520, according to GoodRx, making it the second most expensive new drug of 2022 so far.

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Insulin

Insulin

An autoinjector formulation of insulin.
An autoinjector formulation of insulin.
Photo: Shutterstock (Shutterstock)

Insulin is naturally produced by our pancreas and plays a key role in regulating our blood sugar, a balance that’s vital to maintaining our overall health. People with type 1 diabetes need to take insulin regularly, since they can no longer produce it on their own, while some with type 2 diabetes may have to take it as well.

Despite being available for more than a century, the average price of insulin has surged in recent years. There are many forms of synthetic insulin, which can differ in how fast they begin to affect the body and how long they remain in a person’s system. And companies have lately started to charge much more for the most popular types. People have routinely needed to pay hundreds a month or more for their insulin, and in 2020, Medicare patients collectively spent over $1 billion on insulin. There have been recent reforms to cut down on insulin costs, including a $35 monthly out-of-pocket cap for Medicare patients that was mandated by the Inflation Reduction Act, but the new law doesn’t apply to private insurance patients, nor will it directly lower prices.

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Zolgensma

Zolgensma

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Zolgensma is a gene therapy treatment intended for people with a rare group of genetic conditions known as spinal muscular atrophy. The treatment provides patients with a healthy copy of the SMN gene, allowing their cells to produce SMN protein, which is vital to the health of motor neurons.

The single-dose treatment costs an astonishing $2.1 million in the U.S. as of mid 2022, which made it the most expensive medication until the approval of Zynteglo in August 2022. It isn’t free of severe side-effects either. The drug’s maker, Novartis, reported in August that two patients in Russia and Kazakhstan died of liver failure weeks after starting therapy. However, the drug’s benefits still outweigh its risks, the company argued.

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Myalept

Myalept

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Myalept is a synthetic version of leptin, a hormone essential to regulating our metabolism and the storage of fat in our cells. It’s taken as an injection and is approved to treat leptin deficiency in people with certain forms of lipodystrophy—conditions where the body is unable to properly store fat.

Myalept currently costs $77,496 a month and around $929,951 a year. It’s notable for being one of the most expensive drugs that can be filled at standard pharmacies, as opposed to being dispensed or administered at a doctor’s office.

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