The New Year is approaching, bringing huge changes in healthcare coverage for most Americans. This recent focus on healthcare costs has highlighted the extreme financial burden of rare diseases; effective therapies may have been developed, but the cost of R & D to the pharmaceutical companies is huge, compared to the number of potential users. Take Hereditary Angioedema; billions of dollars were spent on development of a very effective therapy, 95% of which was spent on unsuccessful drug trials. To recoup this investment, patent rights prevent generic alternatives, and the cost is passed on to the some 1 in 50,000. Each patient spends upwards of $100,000 per year to manage their condition. Perhaps this shake-up will force administrators to examine the real cost of healthcare, from pre-clinical trials to approval.