Background: Evaluate cost-effectiveness of olaparib, an oral PARP inhibitor, which unlike many other drugs administered via IV infusion, is outside the sphere of Medicare coverage. Methods: With the exception of olaparib, only IV drugs approved for recurrent ovarian cancer were studied, including platinum-based, non-platinum, and bevacizumab-based regimens. Registration trial data was reviewed to estimate toxicity and PFS rates for the different agents. Medicare data for 2015 was used to determine the costs of IV chemotherapy as well as for managing toxicities, infusions, and supportive care. A Markov model was created in TreeAge Pro 2015. Nodes in the Markov chain allowed patients to transition through response, hematological complications, non-hematological complications, progression, and death. Incremental cost-effectiveness ratios (ICER) were calculated for each group. Survival for ovarian cancer was reported in quality adjusted life months, with the adjustment occurring from a baseline of having recurrent ovarian cancer during a given month. Results: Platinum-based combinations were most cost-effective at $1,672/PFS mo as compared to non-platinum agents ($6,688/mo), olaparib ($10,291/mo), and bevacizumab-containing regimens ($12,482/mo). By adding $81,108 prior to progression, costs associated with olaparib therapy were 5.3X more than platinum-based combinations. When using 4^th line data, the only positive ICER using 4^th line data was for non-platinum drugs ($35,567 extra cost for 1 PFS month). Using probability adjusted to 2^ndline olaparib treatment, olaparib’s ICERs’ are $5,225 for bevacizumab, $16,347 for non-platinum, and $51,935 for platinum treatment. Conclusions: Despite an uncommonly high 34% response rate among germline BRCA+ patients with measurable, recurrent ovarian cancer, the high cost of olaparib was not balanced by costs of infusion and managing toxicities of IV drugs typically associated with 20% RR and hypothetically shorter time to progression in the 4^th line setting. Reconciliation of incremental clinical benefits with new cost prohibitive therapies remains problematic.