What a menin inhibitor costs: the list price, worked out for an infant
also called revumenib price · Revuforj WAC · ziftomenib price · menin inhibitor cost per month
Revumenib's published list price is $10,000 for thirty 25 mg tablets and $19,750 for thirty of the larger tablets. Worked through the label's own dosing table, that is roughly $40,000 a month for a small infant and about $79,000 a month for an adult, and the label says to treat for at least six months.
The same thing, for a scientist
Syndax's state-mandated wholesale acquisition cost disclosure of 19 March 2025 gives REVUFORJ (revumenib) at $10,000 per 30 tablets of 25 mg and $19,750 per 30 tablets of both 110 mg and 160 mg. The label's weight- and BSA-based dosing table converts these into course costs: an infant at BSA 0.4 m2 takes 50 mg twice daily, four 25 mg tablets a day, ~$40,000 per 30 days at WAC; an adult at or above 40 kg takes 270 mg twice daily, ~$79,000 per 30 days. The label instructs a minimum of six months of treatment in the absence of progression or unacceptable toxicity, so a minimum course is on the order of $240,000 for an infant and $474,000 for an adult at list. Ziftomenib (KOMZIFTI) is reported at $48,500 WAC for a one-month supply and is approved for adults only. WAC is not what anyone pays.
The verified list prices3 deeper
Colorado law requires manufacturers to disclose wholesale acquisition cost in writing to prescribers. Syndax's disclosure, priced as of 19 March 2025, is the primary source 1.
| NDC | Product | Strength | Unit size | WAC |
|---|---|---|---|---|
| 73555-0500-00 | REVUFORJ | 25 mg | 30 tablets | $10,000.00 |
| 73555-0501-00 | REVUFORJ | 110 mg | 30 tablets | $19,750.00 |
| 73555-0502-00 | REVUFORJ | 160 mg | 30 tablets | $19,750.00 |
Per tablet that is $333.33 (25 mg) and $658.33 (110 mg and 160 mg). The disclosure states plainly that WAC 'does not represent actual transaction prices and does not include discounts, rebates or reductions in price' 1.
Converting price to a course, using the label's own dosing table
The REVUFORJ label dosing table for patients one year and older gives 270 mg twice daily at 40 kg or more, and 160 mg/m2 twice daily below 40 kg, halved to roughly 95 mg/m2 with a strong CYP3A4 inhibitor. Treatment continues until progression or unacceptable toxicity, with a minimum of six months to allow time for response 2.
| Patient | Label dose | Tablets per day | 30-day WAC | 6-month minimum |
|---|---|---|---|---|
| Infant, BSA 0.4 m2 | 50 mg twice daily | 4 x 25 mg | ~$40,000 | ~$240,000 |
| Infant, BSA 0.4 m2, on azole (strong CYP3A4i) | 25 mg twice daily | 2 x 25 mg | ~$20,000 | ~$120,000 |
| Child, BSA 0.8 m2 | 135 mg twice daily | 2 x 110 mg + 2 x 25 mg | ~$59,500 | ~$357,000 |
| Adult, >=40 kg | 270 mg twice daily | 2 x 160 mg + 2 x 110 mg | ~$79,000 | ~$474,000 |
| Adult, >=40 kg, on azole | 160 mg twice daily | 2 x 160 mg | ~$39,500 | ~$237,000 |
This arithmetic is this node's own; the two inputs are verified primary sources 12. Note that the widely repeated figure of roughly $39,500 per month for revumenib corresponds to the CYP3A4-inhibitor-reduced adult dose, or equivalently to one bottle each of the two larger strengths. At the full label dose without an azole it is twice that. Anyone quoting a single monthly price for this drug without stating the dose is quoting a number that is wrong for most patients.
Ziftomenib, and the fact that the cheaper-looking one is not for children
KOMZIFTI (ziftomenib) is reported at a wholesale acquisition cost of US$48,500 for a one-month supply, and is approved for adults with relapsed or refractory NPM1-mutant AML who have no satisfactory alternative treatment 3. Its once-daily dosing makes the per-month figure directly comparable to the ~$79,000 adult revumenib figure above.
The important point is not the price gap. It is that the second menin inhibitor to reach the market carries no paediatric indication at all. A platform argument that counts ziftomenib as evidence that mechanism-directed drugs serve rare paediatric populations has to reckon with an approved label that excludes every child. See platform-counterargument-adult-commercial-gravity.
What WAC is not
WAC is a published catalogue price to wholesalers. It excludes the 340B ceiling price that most children's hospitals pay, statutory Medicaid rebates (and most infants with leukemia in the US are on Medicaid or CHIP, see cost-family-financial-toxicity-infant-leukemia), commercial rebates, and manufacturer patient-assistance programmes. Net realised price for a paediatric course is very likely materially lower than the figures above and is not public.
The figures are still the right ones for two purposes: comparing menin inhibitors to each other, and setting the order of magnitude against which a platform's development cost per child must be judged.
| caveat | WAC only; excludes 340B, Medicaid rebate, commercial rebates and patient assistance. Net paediatric price is not public. |
|---|
drug prices — the numbers behind the chart
[
{
"drug": "drug-revumenib",
"brand": "REVUFORJ",
"strength_mg": 25,
"pack": 30,
"wac_usd": 10000,
"per_tablet_usd": 333.33,
"as_of": "2025-03-19"
},
{
"drug": "drug-revumenib",
"brand": "REVUFORJ",
"strength_mg": 110,
"pack": 30,
"wac_usd": 19750,
"per_tablet_usd": 658.33,
"as_of": "2025-03-19"
},
{
"drug": "drug-revumenib",
"brand": "REVUFORJ",
"strength_mg": 160,
"pack": 30,
"wac_usd": 19750,
"per_tablet_usd": 658.33,
"as_of": "2025-03-19"
},
{
"drug": "drug-ziftomenib",
"brand": "KOMZIFTI",
"strength_mg": null,
"pack": "1 month",
"wac_usd": 48500,
"as_of": "2026-01-09",
"source_quality": "secondary/news"
}
]derived course costs usd — the numbers behind the chart
{
"infant_bsa_0_4_per_30_days": 40000,
"infant_bsa_0_4_with_cyp3a4i_per_30_days": 20000,
"child_bsa_0_8_per_30_days": 59500,
"adult_per_30_days": 79000,
"adult_with_cyp3a4i_per_30_days": 39500,
"label_minimum_course_months": 6
}- Per milligram, the paediatric strength is the most expensive one: $13.33/mg at 25 mg versus $4.11/mg at 160 mg. If that pattern is general, a platform that produces custom paediatric therapies produces the least cost-efficient products in every portfolio it enters, which is precisely the incentive that keeps sponsors in adults.
- A minimum six-month label course at $40,000-$79,000 a month sets a price expectation for every future mechanism-directed rare-disease asset. If the platform argument succeeds, it succeeds into a market where payers have already seen menin inhibitors priced near half a million dollars a course.
- Quoting the circulating ~$39,500 monthly figure without the dose caveat understates adult cost twofold and will be caught by anyone with the label in front of them.
- What is the actual net price a children's hospital pays for a paediatric revumenib course after 340B and Medicaid rebate, and can any published state or payer dataset reveal it?
- Is there a state WAC disclosure or FDA label for ziftomenib that confirms the $48,500 monthly figure from a primary source?
- Does a weight-based paediatric course, which uses far less drug than an adult course, attract a proportionately lower price, or does the 25 mg bottle price make small patients disproportionately expensive per milligram? At $333/tablet for 25 mg versus $658 for 160 mg, the infant pays roughly 3.2 times as much per milligram as the adult.
- E1established confidence 5 of 5: Multiple independent lines of evidence; treated as settled in the field.news
Syndax's Colorado prescriber disclosure, priced as of 19 March 2025, lists REVUFORJ wholesale acquisition cost as $10,000.00 per 30 tablets of 25 mg, $19,750.00 per 30 tablets of 110 mg, and $19,750.00 per 30 tablets of 160 mg, and states that generics are not available and that WAC does not represent actual transaction prices.
Wholesale Acquisition Cost Information for Colorado Prescribers: REVUFORJ (revumenib) · Syndax Pharmaceuticals, Inc. · Syndax Pharmaceuticals (state-mandated disclosure) 2025What this evidence cannot show
A manufacturer disclosure mandated by Colorado law, so it is authoritative for list price but is a company document and is dated 19 March 2025; prices change. It says nothing about net price.
Evidence that argues against this (2)
- List price is not what the sponsor's own economic model uses. The Syndax-sponsored budget-impact analysis published in JMCP (2025, US commercial payer perspective, cost year 2024 USD) states that 'The wholesale acquisition cost (WAC) was used for the drug costs of treatments ... sourced from the RED BOOK online database (Truven Health Analytics)' and enters revumenib at $36,867 per 28-day cycle. That figure is arithmetically identical to two 30-tablet bottles at $19,750 pro-rated to 28 days ($39,500 x 28/30 = $36,867), i.e. two tablets a day -- the 160 mg twice-daily strong-CYP3A4-inhibitor-reduced adult dose, not the 270 mg twice-daily full label dose this node prices at ~$79,000 per 30 days. So the manufacturer's own published model assumes adult consumption at roughly half the node's headline adult figure. Full text read at PMC12205252. Abraham I et al. 2025
- At payer level the price is a rounding error, which undercuts any argument that cost is what keeps this drug from patients. The same BIM estimates 1.7 treatment-eligible adults per year in a hypothetical 1-million-member US commercial plan, three-year total plan costs of $2,146,564 without revumenib and $2,126,919 with it -- a saving of $19,646 and a differential of -$0.0005 per member per month -- and concludes that adding revumenib to formulary was 'approximately cost neutral'. This is a Syndax-funded model with three Syndax employees among the authors and should be read as such, but it is the only published economic evaluation of the drug and it says the opposite of 'unaffordable'. Abstract read via PubMed; cost inputs and conflicts read in the PMC full text. Abraham I et al. 2025
- E2established confidence 5 of 5: Multiple independent lines of evidence; treated as settled in the field.database
The REVUFORJ prescribing information (revised 11/2024) gives, for patients 1 year and older, 270 mg twice daily at 40 kg or more and 160 mg/m2 twice daily below 40 kg (160 mg and 95 mg/m2 respectively with a strong CYP3A4 inhibitor), with a BSA table specifying 50 mg twice daily at BSA 0.4 m2, tablet strengths of 25, 110 and 160 mg, and instruction to treat for a minimum of 6 months absent progression or unacceptable toxicity.
REVUFORJ (revumenib) tablets, for oral use: US Prescribing Information · Syndax Pharmaceuticals, Inc. / US Food and Drug Administration · FDA Drugs@FDA (NDA 218944) 2024What this evidence cannot show
The initial November 2024 label; it has been supplemented since (an NPM1-mutant indication followed in 2025) and dosing tables may have been revised. BSA 0.4 m2 is used here as a representative infant value and is not itself from the label's clinical data.
Evidence that argues against this (2)
- The label's six-month minimum is not what patients actually receive, so every 'six-month minimum course' figure in this node overstates realised drug spend by roughly 2.5-fold. The JMCP budget-impact model enters a median duration of treatment for revumenib of 2.39 months (US, 2024 USD, adults). At the model's own $36,867 per 28-day cycle that is about $95,000 of drug per adult course, against this node's ~$474,000. Read in the PMC12205252 full text (model input table). The node's own figures are correct as label-and-list arithmetic; they are not correct as an estimate of what is spent. Abraham I et al. 2025
- No published economic evaluation covers the population this beat exists for. The JMCP model states that 'the BIM assumed that all plan members were adults younger than 65 years for both AML and ALL ... because limited treatments were approved in pediatric populations, the BIM did not include pediatric patients.' So the infant and child course costs in this node -- which are this graph's own arithmetic on label plus WAC -- have no published counterpart anywhere, and there is no external number to check them against. Read in the PMC12205252 full text. Abraham I et al. 2025
- E3moderate confidence 3 of 5: One strong study, or several smaller consistent ones.news
KOMZIFTI (ziftomenib) carries a wholesale acquisition cost of US$48,500 for a one-month supply and is approved for adults with relapsed or refractory AML with a susceptible NPM1 mutation who have no satisfactory alternative treatment options.
How Komzifti Is Rewriting The Kura Oncology (KURA) Story For Analysts And Investors · Simply Wall St / Yahoo Finance · Yahoo Finance 2026What this evidence cannot show
A secondary financial-press source dated 9 January 2026, not a manufacturer disclosure or an agency document. The $48,500 figure should be replaced with a state WAC disclosure or the FDA label before it is used in anything public. The indication wording was not verified here against the approved label.
Evidence that argues against this (2)
- Searched and not resolved: the $48,500 ziftomenib monthly WAC still has no primary source in this graph. On 2026-09-18 I searched for a Kura Oncology state wholesale-acquisition-cost disclosure equivalent to the Syndax Colorado document used for [E1], searched Kura's investor-relations releases (including the FDA-approval release and the first-commercial-sale release), and searched for a KOMZIFTI FDA label; none returned a manufacturer or agency document stating the price. The figure does appear in an indexed peer-reviewed venue -- a 'New Drugs' editorial by Paul Beninger, 'KOMZIFTI (Ziftomenib)', Clinical Therapeutics 2025;48(1):129-130, PMID 41453827, doi 10.1016/j.clinthera.2025.12.010 -- but the publisher returned HTTP 403 to every retrieval attempt, so I did not read it and cannot confirm what price it states. The correct status of this number is 'widely repeated, primary source not located', not 'verified'. Until someone reads the Clinical Therapeutics editorial or a Kura state disclosure, the $48,500 should not be used in anything public. Beninger P 2025
- The claim that 'the second menin inhibitor to reach the market carries no paediatric indication at all' is true of the label and misleading about the programme. ClinicalTrials.gov record NCT06376162 (ITCC-101/APAL2020K), 'A Phase 1 Trial of Menin-inhibitor Ziftomenib in Combination With Chemotherapy for Children With Relapsed/Refractory KMT2A-r/NUP98-r/NPM1-m Acute Leukemia', is sponsored by PedAL BCU, LLC with Kura Oncology as a named collaborator, has a minimum age of 0 Years and a maximum of 21, lists sites in the United States, Canada, Austria, France, Italy, the Netherlands and Spain, started 2025-03-18 and is RECRUITING with a planned enrolment of 20. Read from the ClinicalTrials.gov API v2 record on 2026-09-18. Ziftomenib is being given to children, with the manufacturer participating; the adults-only label reflects the registrational route, not the development programme. PedAL BCU et al. 2026
Counter-evidence (Abraham 2025, PMID 40459635): the node's '$72 million of drug for 300 infants' uses label-minimum list arithmetic; the sponsor's own budget-impact model uses $36,867 per 28-day cycle (2024 USD, US WAC) and a median treatment duration of 2.39 months, which puts the same 300 infants nearer $29 million.
Counter-evidence (Abraham 2025, PMID 40459635, PMC12205252): the only published economic evaluation of revumenib enters drug acquisition at $36,867 per 28-day cycle (RED BOOK WAC, 2024 USD, US commercial payer) -- exactly two $19,750 bottles pro-rated 28/30, i.e. the CYP3A4-inhibitor-reduced 160 mg BID adult dose -- and a median treatment duration of 2.39 months, so realised adult drug spend is ~$95,000 per course, not the ~$474,000 label-minimum figure.
Counter-evidence (NCT06376162 ITCC-101/APAL2020K, read 2026-09-18): ziftomenib is in an open paediatric trial with a MINIMUM AGE OF 0 YEARS across seven countries with Kura Oncology as a named collaborator, so the adults-only KOMZIFTI label describes the registrational route and not the development programme. Separately, the $48,500 monthly WAC in this entry still has no primary manufacturer or agency source (searched 2026-09-18).
Counter-evidence (Abraham 2025, PMID 40459635 vs Thai estimate PMID 33109678): one 28-day cycle of revumenib at US wholesale acquisition cost ($36,867, 2024 USD) is about 4.5% of Thailand's entire estimated 2017 national ALL chemotherapy budget (US$814,952 for 318 children) and roughly 14 times the per-child cost of a complete conventional course. 'The drugs are cheap' is a statement about off-patent generics only.
verified WAC and label-dose course cost
reported $48,500/month WAC, adults only
price x eligible population sets the commercial case
generic chemotherapy costs ~$2,563 per child versus $79,000 per adult drug-month
one avoided transplant ~ 3.5 infant drug courses at list
orphan exclusivity supports the price for the exclusivity period
- ← related toThe same pocket suppresses JUND: menin inhibition's unmeasured endocrine liability in infants
any cost-effectiveness model that omits delayed endocrine surveillance and late-effect management is understating the lifetime cost