In ‘march-in’ rights, some see a tool to lower drug prices. Others see a threat to intellectual property

In the fall of 2020, Robert Sachs was prescribed a medication to treat prostate cancer that had metastasized into some of his bones. He welcomed the treatment, but was surprised by the $740 monthly copay cost, even after coverage from Medicare and supplemental insurance.

So Sachs began reading about the drug, Xtandi, and found the annual list price at the time was about $156,000, or $427 a day, for men with commercial health insurance. He also learned that price created controversy because the medicine, which is sold in the U.S. by Pfizer and Astellas, was largely developed at a university with funding from the U.S. government.

“When I started on Xtandi, I was struck by the large copay cost for my first 30-day supply,” said Sachs, 75, a former attorney who spent much of his career as an executive in the cable and telecommunications industry. “And I wondered why. What I learned was shocking. And it took me down this path where I felt it was necessary to raise objections.”

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