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Elaine Thompson / AP

The biggest question on everyone's minds yesterday following the FDA's decision to approve Novartis' new cancer drug therapy known as CAR-T: What's the price? Now we know: $475,000 for a one-time treatment. And that does not include any other costs like doctors' fees or staying in an intensive care unit, so a full course of CAR-T treatment could cost well above a half-million dollars.

Why it matters: The lofty figure represents another heated episode in the nation's debate over high drug prices versus the diseases they attempt to cure.

Here's some of the aftermath from the CAR-T approval and Novartis' pricing decision:

  • The price is actually lower than what biotech investors had expected, and it's lower than the $649,000 price tag British health officials thought was justified. Novartis executives defended their position by implying they could have charged more.
  • But as veteran Forbes pharma reporter Matthew Herper wrote, "When I first started reporting on CAR-T four years ago, people had trouble imagining a $400K price. Now $475K is 'cheap.'"
  • The initial patient population of children and young adults is small, perhaps fewer than 700. At $475,000, Novartis would max out at around $300 million of revenue — a lot of money, but hardly a blockbuster. The ultimate goal is to expand the therapy to more types of cancers.
  • Walid Gellad, a doctor and health policy professor at the University of Pittsburgh, told me the real question is why a potential breakthrough drug that has some question marks about effectiveness should cost more than proven life-saving measures like bone marrow or kidney transplants.
  • "This is an amazing therapy, but there has to be a limit at which point companies can no longer charge desperate patients, or taxpayers, enormous sums," he said.
  • More than $200 million of federal money went to universities and research labs to help discover CAR-T, and "Novartis has not acknowledged the significance of taxpayers' investment," said David Mitchell, founder of the independent advocacy group Patients for Affordable Drugs.
  • Francis Collins, director of the National Institutes of Health, wrote in a blog post that CAR-T is a promising therapy, but he also provided a reality check: "There are still too many severe reactions, too many non-responses or relapses, and, potentially, a very high price tag for their widespread use, which will be truly challenging to scale up."

The Centers for Medicare and Medicaid Services said Novartis' drug, and the company's commitment to only get paid if patients benefit within the first month of treatment, will push the agency to explore more "innovative payment models."

Omitted from the press release: Any details of how outcomes-based contracts would be designed, and how they would actually lower costs.

Go deeper

10,000 trees near giant sequoia groves to be removed after fires

A firefighter looks up at a giant sequoia tree after fire burned through the Sequoia National Forest near California Hot Springs, California, on Sept. 23. Photo: Patrick T. Fallon/AFP via Getty Images

"Upwards of" 10,000 trees near giant sequoia groves have been "weakened by drought, disease, age, and/or fire" and must be removed in the wake of California's wildfires, the Sequoia and Kings Canyon National Parks announced.

Why it matters: The damage to these trees, considered "national treasures," and work to remove them means a nearby key highway must remain closed to visitors as they have "the potential to strike people, cars, other structures, or create barriers to emergency response services," per a statement from the national parks.

Obama stumps for McAuliffe, urges Virginians not "to go back to the chaos"

Photo: Win McNamee/Getty Images

Former President Barack Obama framed a Nov. 2 gubernatorial race as a bellwether for the Democratic Party and the country, telling a crowd at a campaign event for Terry McAuliffe on Saturday that "I believe you, right here in Virginia, are going to show the rest of the country and the world that we're not going to indulge in our worst instincts."

Why it matters: With just over a week to go before Election Day in the Commonwealth, McAuliffe is bringing out the big guns. The 44th president appeared on the campus of Virginia Commonwealth University to urge supporters to get to the polls.

Bryan Walsh, author of Future
5 hours ago - Politics & Policy

Axios AM Deep Dive: America’s murder surge

Photo illustration: Sarah Grillo/Axios. Photo: Erik McGregor/LightRocket via Getty Images

Homicides rose at the fastest rate in at least six decades last year. This Axios AM Deep Dive, led by Future correspondent Bryan Walsh, looks at the state of gun crime.