Moreover, biomedical research firms are abandoning certain diseases in order to avoid the large-scale trials that they require, focusing instead on “orphan diseases” like cystic fibrosis, which demand smaller clinical trials that have a higher probability of success, leading to drugs that can cost more than $100,000 annually per patient. But, with insurers and payers worldwide becoming increasingly vigilant about controlling costs, this business model’s long-term prospects are unclear.