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This is how it is in the US for uncommon disorders, but the amount paid out of pocket is often vastly less. People are typically not writing huge checks for these drugs. It's still daunting though. The pharma company charges a lot to recoup the cost of developing and marketing the drug, which is typically paid by Medicaid. The economics wouldn't make it worthwhile develop the drug if it were too cheap.

I don't know the parent story at all, but generally drug companies are allowed to charge $$$$ for certain drugs that are affective for rare conditions, on the basis that it won't be patients who pay for them. Rather payment will ultimately come from government, possibly via an insurer. The idea being that the drugs get made and brought to market when otherwise they would not, because nobody can afford a $20K drug.

https://www.goodrx.com/xyrem

> Retail price of $21,239.97

The site is misleading in that they indicate you can just buy it from any pharmacy. But that's not how it works.

More details at: https://en.wikipedia.org/wiki/Sodium_oxybate#Cost