A Case of Excessive, Opportunistic Price Increase of a Generic Oncology Drug

Background: Off-patent, generic drugs are expected to be widely accessible owing competitive pricing and minimal R&D costs. Sudden, excessive, unexplainable, and sustained price increases detrimentally impact the health and welfare of patients and their families. Overlooking such cases encourages repeat behavior that may be legislatively challenging to overcome, thereby impeding the principle of democratization of medicines propagated by the expiration of patent protection. Findings: We analyzed Medicare Part B quarterly payment data over 2020 to 2025 and observed a sudden, steep and sustained increase of over 5000% in the price of floxuridine injection, with the most noticeable spike between October 2022 and January 2023. Comparable increases in magnitude were also corroborated in state Medicaid programs. Plausible explanations, including raw material shortage, regulatory changes, formulation changes, and change in patent status, did not support the steep price hike. Market exit of manufacturer(s) to the point of exclusivity appears to be the only reasonable explanation for the price hike. Conclusions: We conclude that although legally permissible, the opportunistic excessive pricing of floxuridine originates from market consolidation and supplier exclusivity. This case reflects a broader concern that generic drugs may be subject to morally questionable pricing. As floxuridine becomes more widely available through ongoing clinical trials, concerns about its affordability and financial toxicity will be difficult to ignore. Floxuridine serves as a cautionary tale of how niche-market generics can evade public scrutiny while imposing unnecessary costs on our healthcare system.