26 November 2018 - A little more than a year ago, I wrote the story of a cancer drug developed by a tiny company called Loxo Oncology. 

The medicine only helped patients whose cancer was driven by a particular, rare mutation, but it helped those patients dramatically. It was still not a cure, and I told the story of a child who was failed not only by that medicine, larotrectinib, but also by a successor compound.

Since then, Loxo signed a deal licensing larotrectinib to Bayer, giving the German drug giant the responsibility for setting the medicine's price. Today the drug was approved by the Food and Drug Administration under the brand name Vitrakvi for patients whose cancer tests positive for a type of mutation known as a gene fusion in a gene called the neurotrophic receptor tyrosine kinase, or NTRK. It's a triumph for the small company. And Bayer set a price.

In an oral capsule form for adults, Vitrakvi will have a wholesale acquisition cost of $32,800 a month for a 30-day supply of 100 milligram capsules. That's $393,600 annually. A liquid oral formulation for some children and adults will cost $11,000 a month for certain paediatric patients, Bayer says. This is not, Bayer insists, what patients will pay. The company says monthly out-of-pocket costs for the majority of patients will be $20 or less. "Bayer will ensure that no eligible patient with TRK fusion cancer will go without this highly effective therapy," the company said in a statement.

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