Rafael Fonseca, MD, from the Mayo Clinic Cancer Center, Phoenix, AZ, discusses real-world implication of the cost of myeloma treatment, both for patients and the healthcare system, and how this correlates with survival at the American Society of Hematology (ASH) Congress 2016 in San Diego, CA. This study of almost 20 000 patients combined insurance claims with survival data. Dr Fonseca describes the study results, which show that myeloma survival is increasing, linked to new medication. However, to his surprise, a very large number of patients still don’t receive the state-of-the-art treatment. Treatment costs have increased substantially over the last few years, but this is a composite of both the drug itself and other factors such as outpatient diagnostics and hospital stays. Dr Fonseca argues that most debates about the cost of a drug don’t take into account confidential rebates received during negotiations.