Auxilium has moved closer to product availability of Xiaflex collagenase injection for the treatment of Dupuytren’s contracture by announcing the wholesale drug price: $3250.00 for a single treatment dose. For those who think that this seems high, consider this in perspective. There are many categories of pharmaceutical products. Most commonly available pharmaceuticals are classified as “small molecule” drugs: organic compounds “small” enough to be able to be absorbed directly into cells. Some small molecule drugs, such as morphine, penicillin, aspirin and cortisone have been used for years; others are new, like the cancer drug Gleevec. In contrast, “biologics” are complex large molecule organic compounds. Biologics are much more difficult (expensive) to purify than small molecule drugs. They are often produced using costly recombinant DNA technology. Biologics include Enbrel for rheumatoid arthritis, Botox for spasticity, and now Xiaflex for Dupuytren’s contracture. Each of these biologics reduces the need for surgery for a specific condition. They are expensive, but cheaper than surgery. Who is going to pay for Xiaflex? The same sources that pay for surgery: private insurance, Medicare, or, if neither is available, the patient. The paperwork will be different, but the process will be quite similar. Auxilium has a patient information site http://xiaflex.com and physicians can call 1-877-663-0412 to get more information. Xiaflex cost should be compared not just to open surgery, which is widely available but more expensive, but also to needle aponeurotomy, which is less expensive than Xiaflex but available at fewer centers. Confusing? Somewhat, but it’s great to have several options for treatment while we continue work to develop a true cure.