This past November @GoodRx released a list of the top 20 most expensive outpatient drugs in the U.S. Since then, things have changed, and not for the better.

As it turns out, in just four months, three drugs moved up on the list after price hikes, and one recently approved cancer drug has made the most expensive list. All 20 of these drugs are priced over $25,000 for a monthly supply, and while some are for rare genetic disorders, others have been around for years.