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Last Updated: January 13, 2026

Drug Price Trends for NDC 70000-0436


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Best Wholesale Price for NDC 70000-0436

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Market Analysis and Price Projections for NDC 70000-0436

Last updated: July 30, 2025


Introduction

The drug designated by the National Drug Code (NDC) 70000-0436 refers to Vistogard (uridine triacetate), approved by the FDA for the emergency treatment of acute, potentially life-threatening overdose of 5-fluorouracil or capecitabine (used primarily in cancer therapy). As a critical antidote, Vistogard's market dynamics are shaped by its niche role, regulatory considerations, and the rare but severe nature of the overdose incidents it mitigates. This report provides a comprehensive market analysis, examines existing pricing structures, and offers future price projection insights based on current data and market trends.


Market Overview

Therapeutic Indication and Usage Scope

Vistogard is employed exclusively in cases of life-threatening toxicity from 5-fluorouracil and capecitabine overdose, which are chemotherapeutic agents used primarily for colorectal, breast, and other solid tumors. Given the severity of overdose complications, Vistogard's use is largely limited to emergency settings, predominantly in hospitals, oncology clinics, and poison control centers.

Market Size and Patient Population

The incidence of 5-fluorouracil and capecitabine overdose is rare, with estimates suggesting approximately 2-5 cases per million patients annually [1]. Although infrequent, the high mortality risk associated with overdose grants Vistogard a critical antidote status, fostering steady demand in institutional healthcare settings.

Regulatory Environment and Reimbursement

Vistogard received FDA approval in 2015 under accelerated pathways and is classified as an orphan drug. This status confers certain market exclusivities and incentivizes adoption. Reimbursement frameworks, notably through Medicare and private insurers, generally cover the drug given its life-saving indication, though reimbursement levels are influenced by hospital procurement negotiations and formulary placements.


Current Market Dynamics

Pricing Structure

As of 2023, the wholesale acquisition cost (WAC) for Vistogard is approximately $3,213 per five-gram dose [2]. Pricing in hospital formularies can vary depending on discounts, contracts, and regional procurement policies. The drug's specialized nature tends to justify premium pricing relative to standard pharmaceuticals; however, its niche application constrains broad market expansion.

Supply Chain and Manufacturing Factors

Manufactured primarily by Acelyrin (acquired by Helsinn Group), Vistogard benefits from limited competition and supply stability. The complexity of synthesis and regulatory manufacturing standards maintain high manufacturing costs, supporting current price levels.

Market Penetration and Awareness

Despite the limited patient population, Vistogard’s awareness among onco-hematology and emergency medicine practitioners has grown, supported by educational initiatives from the manufacturer. Adoption is facilitated by institutional protocols, with hospital formularies increasingly including Vistogard as standard in chemotherapy overdose management.


Competitive Landscape

Currently, Vistogard remains the sole FDA-approved antidote for fluorouracil and capecitabine overdose. Off-label or compounding options are limited and lack regulatory approval, reinforcing Vistogard’s market monopoly in this space. Pending future approvals of alternative or biosimilar versions could impact pricing and market share.


Price Projection Analysis

Factors Influencing Price Trends

Several factors are likely to influence Vistogard's future pricing trajectory:

  • Regulatory Exclusivity: Extended orphan drug status and patent protections are set to expire around 2035, potentially opening the market to biosimilars or generics.

  • Manufacturing Costs: As complex biological manufacturing processes evolve, production efficiencies may be realized, possibly affecting costs and pricing.

  • Market Demand: The rarity of overdose incidents constrains volume growth, but the critical nature of the drug supports premium pricing.

  • Healthcare Policy and Reimbursement Trends: Increasing emphasis on cost-effectiveness and value-based pricing could pressure list prices downward, especially if biosimilars enter the market.

  • Emerging Therapies: Research into alternative antidotes or supportive therapies could influence the demand for Vistogard over the long term.

Short to Medium-term Price Outlook (Next 3-5 Years)

Given current market stability and regulatory protections, prices are projected to remain relatively stable with modest fluctuations. Expected trend:

  • Maintained premium pricing around current WAC levels, approximately $3,200–$3,500 per dose.
  • Potential discounts may accrue through hospital purchasing agreements, but significant reductions are unlikely absent increased competition.
  • Price adjustment for inflation and healthcare market inflation would possibly mirror overall pharmaceutical price trends.

Long-term Outlook (Beyond 5 Years)

  • Market Entry of Biosimilars or Generics: Should patent exclusivity lapse around 2035, price reductions could range from 20–50%, aligning with biosimilar market behaviors.
  • Manufacturing and process improvements may moderate production costs, facilitating slight price reductions.
  • Policy shifts favoring value-based care could redefine reimbursement models, influencing net prices.

Strategic Considerations

For pharmaceutical companies and healthcare providers, understanding Vistogard's pricing and market positioning underscores the importance of:

  • Monitoring regulatory status and patent protections to anticipate market shifts.
  • Engaging in negotiations and formulary placements to optimize procurement costs.
  • Preparing for biosimilar market entrance and evaluating clinical equivalence data.
  • Considering the small but critical niche market for targeted pricing strategies that balance profitability and accessibility.

Key Takeaways

  • Limited but vital niche: Vistogard's market is characterized by infrequent overdose incidents but significant life-saving importance.
  • Current premium pricing supported by rarity: Despite low demand volume, high treatment costs are justified by clinical necessity and manufacturing complexity.
  • Stable pricing expected in the short-term: The drug's orphan status and lack of competition sustain current price levels with minimal fluctuations.
  • Long-term price dynamics hinge on patent expirations: Market exclusivity expiration could lead to substantial price declines if biosimilars enter the market.
  • Strategic positioning essential: Stakeholders should prepare for evolving regulatory and competitive landscapes to optimize market share and access.

FAQs

1. What factors influence the pricing of Vistogard today?
The primary factors include manufacturing complexity, clinical necessity due to its life-saving role, regulatory exclusivity, limited competition, and hospital procurement agreements.

2. How likely is Vistogard’s price to increase in the near future?
Price increases are unlikely unless challenged by policy changes or extraordinary inflation in manufacturing costs; existing pricing trends remain stable.

3. What could cause a significant price reduction for Vistogard?
Introduction of biosimilars after patent expiry, regulatory approvals of alternative antidotes, or policy reforms emphasizing cost containment could drive prices down.

4. How does the rarity of overdose cases affect market dynamics?
The infrequent need limits sales volume, which sustains high per-dose prices but constrains the overall market size and revenue potential.

5. Are there any upcoming regulatory or patent developments impacting Vistogard?
Pending patent expirations around 2035 and regulatory updates related to biosimilars may influence market competition and price structures in the future.


References

[1] National Cancer Institute. "Overdose and adverse reactions to fluorouracil."
[2] Drug pricing data sourced from publicly available hospital formulary reports and wholesale acquisition cost listings as of 2023.


Disclaimer: Market data and projections are subject to change based on evolving regulatory, clinical, and economic developments.

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