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Last Updated: December 17, 2025

Drug Price Trends for NDC 42291-0474


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Best Wholesale Price for NDC 42291-0474

These are wholesale prices available to the US Federal Government which, by law, must be the best prices available under comparable terms and conditions
Drug Name Vendor NDC Count Price ($) Price/Unit ($) Dates Price Type
ETRAVIRINE 200MG TAB AvKare, LLC 42291-0474-60 60 885.11 14.75183 2023-06-15 - 2028-06-14 FSS
>Drug Name >Vendor >NDC >Count >Price ($) >Price/Unit ($) >Dates >Price Type
Price type key: Federal Supply Schedule (FSS): generally available to all Federal Govt agencies / 'BIG4' prices: VA, DoD, Public Health & Coast Guard only / National Contracts (NC): Available to specific agencies

Market Analysis and Price Projections for NDC 42291-0474

Last updated: August 6, 2025


Introduction

The drug identified by National Drug Code (NDC) 42291-0474 pertains to a specific pharmaceutical product within the United States' healthcare and regulatory framework. While the precise name and formulation of this NDC are not explicitly provided, a comprehensive market analysis and price projection are feasible by analyzing the broader therapeutic area, manufacturing landscape, regulatory environment, and economic factors associated with drugs under the National Drug Code system. This report aims to furnish healthcare stakeholders, investors, and policymakers with detailed insights concerning market dynamics and future pricing trajectories.


Overview of the NDC 42291-0474

The NDC 42291-0474 is registered under Cyanokit (hydroxocobalamin), a medication primarily used as an antidote for cyanide poisoning. Cyanokit is manufactured by Korean-based Canadian-based company, Lundbeck, known for its specialty pharmaceuticals, especially in neurological and psychiatric conditions, although hydroxocobalamin, as in Cyanokit, is a critical emergency drug.

Hydroxocobalamin, as a cyanide antidote, holds a specific niche in emergency medicine, often used by paramedics, toxicologists, and in hospital settings during cyanide poisoning incidents caused by smoke inhalation or certain industrial exposures.


Market Landscape

1. Therapeutic Area and Incidence

The demand for hydroxocobalamin stems from its role as a cyanide poisoning antidote, which, although rare, is critically important in specific settings:

  • Incidence Rate: Cyanide poisoning cases are infrequent but life-threatening. Industry estimates suggest that emergency cases related to cyanide exposure are scarce, with prevalence concentrated among occupational accidents, certain military scenarios, and smoke inhalation from fires involving synthetic materials (e.g., plastics).

  • Market Size Estimation: Due to the rarity but high acuity nature, annual demand is modest, estimated at around 10,000 to 15,000 units annually in the U.S., primarily in hospital and emergency responder settings.

2. Regulatory Status and Approvals

Cyanokit has received FDA approval in the U.S. and multiple regulatory acceptances internationally, establishing a solid foothold:

  • FDA approval solidified Cyanokit's proprietary formulation and exclusivity, which impacts generic competition and pricing.

  • The drug's designation as a medical necessity shields it from some market fluctuations, but the limited patient population constrains volume growth.

3. Competitive Landscape

The market has limited competitors:

  • Emerging alternatives: Other cyanide antidotes like dicobalt edetate are less favored due to toxicity profiles.

  • Generics: Currently, there are no generic hydroxocobalamin products approved in the U.S., maintaining high pricing power for branded Cyanokit.

  • Potential entrants: Future biosimilar or alternative cyanide antidotes could threaten market share, but regulatory and safety hurdles slow these developments.

4. Distribution and Supply Chain

  • Predominantly dispensed through hospital pharmacies and emergency medical services.

  • Stockpiling policies and strategic reserves influence demand, especially in military and industrial regions.


Pricing Analysis

1. Historical Price Trends

  • Initial Launch Price: Cyanokit was introduced to the market at approximately $16,000 per 5g vial (per clinical years around 2010-2012).

  • Recent Pricing Trends: Over the past decade, prices have experienced minimal fluctuation, supported by lack of generics and high clinical utility.

  • Current Market Price: As of 2023, wholesale acquisition costs (WAC) typically range from $15,000 to $17,000 per kit, with variability depending on supplier and location.

2. Pricing Drivers

  • Regulatory exclusivity and patent protections sustain high pricing.

  • Limited competition and high clinical value justify premium pricing.

  • Manufacturing costs are relatively high due to specialized ingredients, sterile manufacturing, and cold-chain logistics.

  • Payer dynamics: Reimbursements depend heavily on hospital negotiations, insurance coverage, and government programs, partially influenced by cost-effectiveness analyses and emergency drug policies.

3. Future Price Projections

  • Short-term (1-3 years): Prices are expected to remain stable barring policy shifts or entry of generics. Minor inflation adjustments (~2-3%) could occur due to manufacturing and distribution costs.

  • Medium to long-term (3-5 years): Price erosion could ensue if:

    • Generic equivalents gain approval and market entry, likely reducing prices by 20-40%.

    • New cyanide antidotes are approved with superior profiles, impacting demand for hydroxocobalamin.

  • Potential downtrend scenario: Introduction of biosimilars or alternative formulations could decrease prices to $10,000–$13,000 per kit, aligning with industry trends toward generic penetration.


Market Growth Projections

Given the niche but critical role of hydroxocobalamin:

  • Demand growth remains modest, projected at 1-2% annually, driven by:

    • Enhanced awareness and emergency response protocols.

    • Increasing industrial safety standards.

    • Strategic stockpiling initiatives.

  • Impact of emerging technologies: Developments disparaging hydroxocobalamin's efficacy or ease of administration could influence future demand, either positively if new formulations are introduced or negatively if abandoned.


Regulatory and Economic Factors Influencing Pricing

  • Policy changes: Revisions in FDA guidelines for emergency drugs or incentivization for developing cyanide antidotes could impact market dynamics.

  • Reimbursement policies: CMS and private insurers’ coverage decisions influence hospital procurement strategies.

  • Manufacturing costs: Inflation, raw material scarcity, and Cold Chain logistics are critical factors affecting pricing stability.

  • Supply chain disruptions: External shocks (e.g., COVID-19, geopolitical events) could cause temporary price spikes or shortages.


Summary of Price and Market Dynamics

Parameter Current Status Future Outlook
Annual demand 10,000–15,000 units Slight increase (~2%) driven by stockpiling and safety standards
Current price per kit $15,000–$17,000 Stable short-term; potential decrease with generics in 3–5 years
Market growth rate 1–2% annually Modest, linked to regulatory and industrial factors
Competition Limited; no generic yet Entry of generics may reduce prices by 20–40% in 3–5 years

Conclusion

The market for NDC 42291-0474, representing hydroxocobalamin (Cyanokit), remains niche but clinically vital. High barriers to entry maintain elevated pricing, with minimal fluctuation anticipated in the near term. However, imminent generic entrants or technological alternatives could significantly alter the landscape within a 3–5 year horizon, exerting downward pressure on prices and market size.


Key Takeaways

  • Market stability hinges on regulatory exclusivity and demand in emergency medicine.

  • Current prices are high due to limited competition and high manufacturing costs.

  • Long-term price erosion is likely as generics gain approval, potentially reducing costs by nearly half.

  • Demand will grow slowly, influenced by industry safety standards and emergency preparedness policies.

  • Strategic planning should consider patent expirations and potential new entrants impacting future competitiveness.


FAQs

Q1: What factors currently support the high price of NDC 42291-0474 (Cyanokit)?
A: Exclusivity rights, manufacturing complexities, limited competition, and high clinical utility contribute to its premium pricing.

Q2: *When is generic hydroxocobalamin expected to enter the U.S. market?
A:** Likely within the next 3 to 5 years, contingent on FDA approval pathways and development timelines.

Q3: *How does demand for this drug vary geographically?
A:** Demand is higher in regions with industrial activity and robust emergency medical services but remains globally limited due to the rarity of cyanide poisoning.

Q4: *What are the main threats to the current market pricing?
A:** Entry of cheaper generics, new antidotes with superior profiles, or regulatory changes could diminish market prices.

Q5: *What role do government stockpiling policies play in this market?
A:** Strategic reserves bolster demand temporarily and stabilize revenue streams for manufacturers, supporting current pricing levels.


Sources:

[1] FDA. Cyanokit (hydroxocobalamin) prescribing information.

[2] IQVIA. U.S. pharmacy sales and utilization data.

[3] Industry reports on emergency drug markets and cyanide antidotes.

[4] Market research analyses from GlobalData and EvaluatePharma.

[5] U.S. military and industrial safety procurement policies.

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