Extremely expensive drugs which cost more than 100.000 $ per year for the treatment of one patient are increasingly common. The benefit of these drugs may either be not accessible to many patients or the overall costs could lead to a heavy burden on the health care system and public resources. This article describes the overall background of this trend and addresses the problem of expensive drugs from a perspective of just health care and just health outcomes. Therefore, basic aspects of just health care are outlined such as goods and principles relevant from a perspective of justice. This framework is applied to the allocation of expensive drugs on three levels. These reflections will demonstrate that there is no simple solution to this problem, and that the decisions cannot be taken by experts, but should be the result of an open, transparent, and fair public dialogue on health priorities.