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In a controversial move, Marathon Pharmaceuticals is charging $89,000 a year for a decades-old drug that was approved by US regulators on Thursday, but has sold for a fraction of the price in other countries. Known as deflazacort, the steroid will be used to treat Duchenne muscular dystrophy, a rare disease that mostly affects young boys, causing muscles to deteriorate and leading to an early death.

The pricing, however, has upset some patient groups, who say that online pharmacies in the UK and Canada sell the medicine for about $1,000 annually, or less than $2 a pill, and the approval will likely preclude imports. They also note the drug received orphan designation, since it treats a rare disease for a small patient population, which means Marathon has seven years of exclusive marketing before rival medicines become available.

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