FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower.
Then the drug companies come in and offer a "savings card" which you apply at the pharmacy like another layer of insurance. I searched and Miebo has one too: https://miebo.blsavingscard.com/ You'd have to read all the fine print, but it reveals that the actual cash-pay price is $225 (still high, obviously) and they have a co-pay assistance program that reduces your copay to $0 to incentivize you to get your insurance billed for this drug. So a lot of people who take this drug in the US actually pay $0 because they sign up for this card.
The FDA is partially to blame for this situation: They required a complete New Drug Application before they would let anyone bring it to market, even though it's over the counter in other countries.
The cost of performing a New Drug Application starts in the mid hundreds of millions of dollars range and can extend into the billions for some drugs.
So nobody could feasibly introduce it to the market here without investing $500 million or more up front. At that price, your only viable option is to stick a big price tag on it and try to milk that money back from insurers.
These "savings cards" have a maximum annual benefit applied to them so for those on insurance that do not cover those expensive medications or who are self-paying use up the benefits before year end and do in fact eventually pay full sticker price.
I was on a blood thinner and the medication was very pricey. Didn't have insurance and the "savings card" covered fuck all unless you had insurance. There are three blood thinners on the US market and they all cost a lot.
If you don’t have insurance, you’re essentially fucked in the US but this thread is not referencing that situation. My CAT scan was billed for $10,000 but what I paid was about $200 with insurance. Without insurance I would owe $10k.
Depending on your situation, if non emergency and you were able to ask the cash price beforehand you might be surprised that you can get the same CT scan for less than what insurance ultimately paid. At least that’s my experience ($450 vs $1200). You may have to ask at a diagnostic imaging place, not the hospital since the hospitals can never tell you what anything costs they aren’t set up for it. (Of course I went through insurance since I didn’t want to pay out of pocket, but it was an interesting lesson in one of the reasons why healthcare is unnecessarily expensive in the US.)
Why stop the conversation here? And if you don't have insurance but go to an ER (can't be turned away) and end up getting some expensive procedure you can't afford, you can just tell them that you're broke and they negotiate way, way down, or even just forgive it. And it's setup like this to ensure only people who have proper full time jobs or who can write a good enough sob story can get care. Because so many of the people in charge of this mess are far more obsessed with blocking out people they can't get enough data on or who aren't working, then figuring out reasonable public prices that make some effort to strike some fair market balance. So that if you have some savings and aren't employed, you are forced to find any job with benefits so you aren't left bankrupt, which makes taking care of health struggles harder as you have to work instead of take care of yourself.
> FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower.
Sure, we do not pay $800 at the pharmacy when we go to pick up the prescription, but every cent the insurance company pays, we are paying by proxie with added admin costs.
The best thing about universal healthcare isn't how much money I may or may not have to pay, it's that I literally don't once have to think about a bill or filling out a form to avoid paying too much.
I wouldn't care if I ended up paying more in tax than I would in an insurance model. The benefit is being able to 100% focus on my health instead of navigating a system to try to reduce what I'm paying.
When you're diagnosed with an illness, that's a huge peace of mind.
Trust me it doesn’t work perfectly in other countries. Yes, americas system is messed up but in countries like Sweden you will still have to navigate the system to actually get the healthcare you need. There are people who are denied healthcare in Sweden because the govt has deemed that it’s too expensive to save them (while people with similar conditions and a good insurance in the US are covered).
> I wouldn't care if I ended up paying more in tax than I would
Here, in the US, you would be burned at the stake for heresy, for saying that.
One of the red-blooded American values, is that Taxes Are Bad, because rich people founded our country on a platform of Don't Tax Me, Limeys, and it has always been designed as a playground for wealth.
And yet, the average American pays more in taxes for public healthcare (medicare, medicaid) that they don't receive any of, than the average European pays in taxes for (some kind of) universal healthcare.
It's so bizarre seeing Americans in the debate not wanting "crazy high taxes like in Europe", because the US already spends twice as much public money per capita as the OECD average.
The dirty secret of course is that healthcare as a good is much more expensive to produce in the US than elsewhere, and a large chunk of that is because the private insurance system adds a ton of unnecessary overhead. And yet all the healthcare insurance companies in the US talk about making healthcare "affordable for all". Yeah, no, they're leeches. They're rent-seekers. They drive up the cost of everything.
The US has a massively progressive tax system. On a net tax basis about 50% of the country pays nothing. Sure, they pay sales tax and employment taxes, but they also receive some mix of earned income tax credits, child tax credits, snap, medicaid, housing, etc. There is no real way for the US to have a single payer tax system without more people actually becoming net tax payers.
Most countries have both public and private. In Spain I have public and then private on top of that which 220 eur a month for a family of four all services included and no co-pay. The public option works to set a roof on what private insurance can charge.
That's usually how it works for me in the US. I go in to the pharmacy, and at least half the time they say 'no cost' and hand me my medication. Sometimes I pay a $25 copay. And if I get an expensive drug from Eli Lilly (e.g. Zepbound) then Eli Lilly pays Walgreens up to $1950/year on my behalf and I never even know about it. The only way I figured it out myself was trying to figure out why my insurance said they paid X, and I paid Y, but I had actually only paid $25. Took a trip onto a Zepbound subreddit to learn about the backdoor payment thing. "Savings card" but not actually a card.
what about the poor people? the ones that can't really afford insurance. i've heard multiple times that epipen prices are crazy expensive and that's a really basic drug.
If you’re really poor, you can get Medicaid. It’s the working poor who earn too much for Medicaid who are really shafted. The ACA tried to fix that for as many as it could, by expanding Medicaid to households making more money; the Republicans shut down the government to fight that expansion. It’s maddening.
There's undoubtedly a significantly lower cash price if you don't have insurance (GP mentions $225). The before insurance prices are meaningless; they're a negotiating tactic between pharma companies and insurers.
If you're poor you just wait until you're borderline dying and then go to the E.R. and get charged $120,000 and then never pay it and then have debt collectors calling you for the rest of your life.
Or you're on Medicaid if you live in a sane state.
> The FDA is partially to blame for this situation: ...
> The cost of performing a New Drug Application starts in the mid hundreds of millions of dollars range and can extend into the billions for some drugs.
> So nobody could feasibly introduce it to the market here without investing $500 million or more up front. At that price, your only viable option is to stick a big price tag on it and try to milk that money back from insurers.
It's interesting that you seem so passionate about this because you're totally incorrect. The cost of a NDA for a novel prescription drug requiring clinical data (the most expensive application) is ~$4.5mil. In fact, the estimated TOTAL revenue to the FDA from ALL PD application fees in FY 2025 is ~$1.3billion (or, just under 300 novel prescription drugs). So, obviously, FDA fees can't be as much as you're claiming.
What you're actually describing is the total cost of the entire drug development pipeline (research, design, lab costs, chemical costs, application costs, marketing costs, etc.) to develop a brand new, novel drug. And it's only ~$200m, increasing to $500m if you include dead ends / failures in the process, and ~$900m if you include both failures and capital costs--yep, that's right the capital costs alone are almost as much as the entire rest of the drug development pipeline.
> So a lot of people who take this drug in the US actually pay $0 because they sign up for this card.
They do not pay $0 because the insurance company raises the rates for all of their customers to cover the cost of all the red tape and time spent negotiating with drug companies over their bullshit. The insurance companies aren't eating those costs, they're profiting from them and it's us who end up footing the bill. By the time you factor in the unnecessary time, staff, record keeping, etc. the actual cost for the $20 drug will be even more than the $800 sticker price.
No matter how our crooked system twists things to make it look otherwise they always make you pay. One way or another.
80% of prescriptions are controlled by 3 companies. You can look up the FTC report on it. All three of them own or are owned by insurance companies.
The insurance companies had their profit percentage capped, and so the only way they could increase profits was by increasing their share of the pie. So they bought medical providers and prescription companies.
Now the insurance company is both the buyer and the seller, but not the one who pays. We pay. So they raise the prices of the drug, raise the cost of insurance, and make a lot more money while staying in their profit percent cap.
All the way around, this is the opposite of a free market and the FTC should be breaking these companies up. And as everybody knows, all the way around, it is immoral, too.
It's a very interesting drug. There are a lot of concerns right now around PFAS in water supplies, for example, and Miebo/Evotears are pure PFAS (perfluorohexyloctane) that's instilled directly in the eye, giving you a dose somewhere around a million times higher than levels of concern in drinking water.
But it is absolutely revolutionary if you have dry eyes. Quotes include "I feel like my eye is actually too wet now"
Visomitin (Emoxipine/Mexidol) eye drops are a Russian-developed antioxidant medication known for treating dry eyes, fatigue, radiation damage, and improving vision, working to protect eye cells from damage (oxidative stress), but it's not widely available or FDA-approved in the US, requiring international purchase or specific prescriptions, often used for cataracts or post-surgery recovery, focusing on cell protection rather than just lubrication like many Western OTC drops.
That would be 1 liter of the active ingredient, not 1 liter of the eye drop. Also I don't believe that 1 ppt of this stuff is harmful when people are putting it directly in their eyes without severe harm.
Largely firefighting foams, industrial and manufacturing, and landfill sources, but it's still an interesting problem. They don't really break down (that's why they're so useful both in a materials science sense and as a medication) which implies they'll stick around for an extremely long time.
Theoretically speaking how much would the components cost if one made it themselves? [1][2] My interests are purely academic as I have no need for this.
According to another comment this product is pure 1-(perfluorohexyl)octane [1]. There's no practical way to make it at home, but if you buy it in bulk from an industrial supplier it can be had for $980-$750/kg, depending on how many kilograms you commit to buy at once:
Add analytical lab services to analyze it for purity and you could still get a lifetime supply for the price of a couple of brand-name bottles. This is the sort of thing that some Americans have been doing to get cheap GLP-1 peptide drugs from overseas too.
"Before insurance" prices aren't real! The headline is misleading; the first sentence of the article is misleading. It drives me crazy. Most Americans absolutely do not understand how insurance works and journalists do their damnedest to keep it that way by constantly misleading them.
If a drug isn't one of the following it should be available over the counter.
1. heinously addictive
2. incredibly dangerous when not used exactly correctly
3. an antibiotic (due to the resistance externality)
And for drugs that do meet one of these conditions, doctors should be able to write lifetime prescriptions for cases where the medication is used to treat a permanent condition. This probably covers 95% of non-antibiotic prescriptions. The savings from removing the gatekeepers in terms of time and money would be massive and the costs would be minimal.
What a brave thing to say on a message board which thinks having a conversation with a chatbot should be illegal lest you ask it how to deal with emotions.
It’s very simple. In the US your pharmacy has a contract with the drug supplier that prevents the pharmacist from telling you that you could buy the drug without insurance for $10 while he charges you the $20 copay. As long as this is legal and your pharmacist’s duty isn’t to you the patient, don’t waste time worrying about the details.
What's to stop congress from passing a blanket "most favored nation" law for VA + medicare on all pricing, inclusive of insurance rates and discounts? Seems like it would be fair and useful.
There is a weird thing Americans often do when confronted with the incredibly high price of medicine and medical care in the US of imagining that every other country is actually responsible for this (hence the "most favored" nonsense). That it's zero sum and every other country is laughing and taking Americans for a ride and underpaying, and therefore Americans have to cover the bill.
This is the angle Trump has taken in some of his incredibly ignorant and stupid screeds on this topic (as with every single position he has on anything): Get everyone else to pay more and somehow the US pays less!
This...isn't at all how it works, or what the problem is. Americans pay more because of the whole massive scam of your Medical Insurance Racket, where everything has imaginary inflated prices and an absolutely massive middle-tier of suits having nothing to do with medicine are taking their cut. This is your problem, reflected almost nowhere else on the planet, and it is domestic caused and will need to be fixed domestically. Criticizing Europe or Canada or anyone else will never, ever fix the utterly, insanely broken and profoundly stupid American system.
But it won't. It's simply incredibly how easily Americans can be fooled into voting against their own best interests, year after year.
The drug in question is perfluorohexyloctane, which is part of a class of substances known as PFAS or „forever chemical“. I‘m a chemist, I love modern medicine and material technologies based on chemistry, and I don’t hesitate to take vaccines or other meds, and I also happen to have SEVERE dry eyes syndrome - but hell no, I’m not going to put that stuff into nature!
Such an easily debunkable line with even the tiniest bit of critical thinking.
You’re basically saying the drug companies subsidise a loss in Europe by over charging Americans, right?
As the drug company is a private and doesn’t have to sell everywhere, why wouldn’t they just skip the loss making Europeans and just sell to Americans? They’d make more profit that way!
That must mean they make some profit from the European prices, otherwise they wouldn’t be bothering.
> You’re basically saying the drug companies subsidise a loss in Europe by over charging Americans, right?
No - once they know how to manufacture a drug, it's dirt cheap for them to do so - they're still making a profit in Europe. The purpose of billing Americans a huge amount (other than they can get away with it), is to fund the research + trials for the next generation of drugs.
Of course, even this argument doesn't hold water. I remember when pharmaceuticals spent more on advertising/marketing than on R&D (may still be the case).
Drug costs are dominated by the fixed costs of development. $20/dose may very well cover the marginal cost of production while being far too little to make the overall venture profitable.
And Medicare cannot negotiate drug prices until 2026 (). Medicare is also banned from re-importing drugs from other countries (ex Canada) at lower prices. Thank you president GWB, the Alliance to Improve Medicare, and AARP (!!!!) https://pmc.ncbi.nlm.nih.gov/articles/PMC1126891/
() Biden's inflation act gave Medicare permission to start negotiating drug prices in 2026. Who know what the current US Administration will do though.
There is no free market at play here. This is the result of FDA regulations not allowing anyone to sell it unless they did a New Drug Application first, which could cost a billion or more. Therefore nobody in the free market was allowed to sell it without putting up the capital first, which they have to collect back now.
You could actually order this from amazon.de up until recently and have it shipped to you. That seems to have disappeared, though.
Drugs and healthcare products should definitely be regulated so people get quality products with provable efficacy. Saying that, how the hell does an application for a new drug with the FDA cost $1Bn?! Clearly something is wrong there.
This is true. When you look at actually free markets -- like the gray markets in bodybuilding drugs, "nootropics," peptides, etc. -- you'll find that there's usually a race to the bottom on price, and that everything is easily affordable out of pocket. Quality also tends to be okay, as lab reports are one of the primary ways that customers rank and differentiate between brands.
And these aren't necessarily old pharma hand-me-downs. There are lots of novel and strange drugs (9-MBC, lol) that you can buy for next to nothing.
Require phase 1 only. That proves safety, but not efficacy. Require the companies to publicly release all data from their evaluations to the public. It's my right to decide on the risk / reward tradeoff, not some worthless bureaucrat to decide for me.
in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money.
in that case, you don't care if you drug cost 10€ or 2000€ because you aren't spending a single € from your own wallet, at least if you don't factor in taxes.
Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get it paid by their own insurance but it cost them directly a lot of money.
I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing. That's just how free market work, and technically there are many medication manufacturer and many customer.
Is it the proof that a true unregulated free market doesn't work ? if left unsupervised, big companies are going to buy smaller companies until they are monopoly or make secret, behind the door, deal to keep price up.
It's what the USA is made on, the idea of freedom and free market. i believe the idea of unregulated market is more recent, think the 70's, but surely in the 50 years since then american would have pushed back against it and not elected people like Trump who are all in.
Americans pay multiples more per capita, and receive worse healthcare based on outcomes compared to European nations. The UK on average has better oral health than the USA, but Americans love to joke about British teeth... I think the US believes it's own "free market" propaganda too much. Clearly socialised universal healthcare (which every G20 nation does outside the US) is a better system.
> I would think that americans would be much more vigilant about what medication they take
This is why I always check to make sure it's fiscally responsible before I start chemotherapy, or before buying that emergency inhaler for asthma, or before accepting paralytics and anesthesia when undergoing surgery. How fortunate that in America diabetics have the freedom to die rather than take overpriced insulin. Let the free market decide which child with leukemia deserves a bone marrow transplant and which deserves a casket! That's a much more responsible market than just having everybody chip in a small amount so that nobody needs to worry about the cost of the medications they need to live. Sure, in America millions will die or be bankrupted by healthcare costs every year, but that's better than spending a single $ from your own wallet if even a tiny fraction of it might help pay for someone else's medications right?
I mean you're joking but there are maybe ~20 brands who produce and sell inhalers. Maybe I need the inhaler but I also have a certain amount of choice, and presumably some are more expensive than others. Insulin is a famous example, because you can buy a vial for ~$30 or a nicer one for $300. They all effectively do the same thing but there is a quality difference between them, usually in regards to release time and how often you'd have to take it.
There are some market pressures in healthcare when multiple companies can compete, although it's so heavily regulated it can be hard to see the market pressures in practice. Consumers often do have some amount of choice though
> I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing.
> Is it the proof that a true unregulated free market doesn't work ?
The market is heavily regulated (frequently crazily) by the FDA, and the actual amount anything costs is heavily obscured from the eyes of any consumers by the fog of bureaucracy and insurance.
Many people have 3-4 tiers of fixed copays that the insurance company makes up - some pharmacies won't even tell you when there is a cash price or a "coupon" that would be cheaper than your insurance copay! And pharmacies don't publish a plain list of what the cash prices are, and it would be hard for most people to even produce the tier formulary, it's buried as a PDF in some obscure page of a horrible website. So we just go to the pharmacy and see what it'll cost us.
Also, one major insurer owns a major pharmacy benefits manager and one of the big 2 pharmacy chains, so they use that to put their thumb on the scale however they can, while the other insurers and PBMs play games to lock consumers into restrictive exclusive deals that are to their detriment.
Anyway we don't have a market at all when it comes to healthcare, because the majority of price information is withheld from consumers until the opportunity to make any choice, if it even existed, is well past.
> Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get it paid by their own insurance but it cost them directly a lot of money.
That's the idea, but in practice there are so many layers of indirect government incentives, disincentives, and direct interventions that market is no longer effective for this purpose.
It's virtually impossible to find out how much a medical procedure actually costs. Most hospitals and clinics refuse to even estimate as a policy, which has led to the creation of things like pre-paid services for labor and delivery. Those are quite rare.
I'm 100% in favor of allowing the market to work - but at this point, we have the worst of both worlds and the best of neither. Either extreme would be better than what we have.
Part of the problem is that the way our healthcare system is setup, it's not even a remotely free market. It's pretty much a worst of all worlds situation.
> I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing. That's just how free market work, and technically there are many medication manufacturer and many customer.
(Not american) This assumes they have a choice, no? Do these medications have real alternatives?
> in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money.
Europe is a big place, buddy. Which particular part are "we" from today?
NHS England has NICE (National Institute for Health and Care Excellence), which does the cost-benefit analysis for all medicines prescribed, nationally. It frequently decides medicines aren't worth the money. If you, as a private citizen, want that particular medicine, you can waste your own money on it. NHS England does not have a moral hazard problem.
The NHS also spends money trying to convince people to exercise, eat well, lose weight, not smoke, look for early signs of cancer, etc., because they find that relatively tiny amounts of money on these campaigns results in massive, massive savings from not having to treat so much preventable disease later in life.
i think healthcare is one market where capitalism just doesn't work well at all. for those areas, it actually makes sense to introduce hard or soft price ceilings.
> Contrary to the USA where it's a much more responsible market,
This is satire? I can’t tell anymore.
I mean the USA is the only country where someone can allegedly murder a healthcare executive for denying treatment and popular culture is engaged in drooling about how well the alleged killer fills out a tailored shirt.
out of curiosity, how much would this drug cost in Europe if they had required prescriptions as well
the article does a good job of showing the self serving double speak and the lack of pursuing an OTC option in the US, but I want to compare costs directly, since the article also acknowledges that OTC would have been much cheaper than $800 in the US too
Europe doesn't have a single health service. There are going to be different prices in different countries under different schemes.
In my EU country I get a subsidy of at least two thirds on most drug prices with a state prescription. But the nominal cost is already negotiated down by state purchasing, and I suspect there's some EU cooperation there. So it's impossible to say what the "normal" price would be.
The cost of the paperwork depends on your doctor. I pay €3 for new paperwork a few times a year.
You can get many drugs OTC here without a prescription - more expensive, but it always surprises tourists who suddenly discover they can get many common meds (except for things like antibiotics and steroids) just by asking.
Why is it eye medication seems to be the market with the slimier moves? Sudden memories to when Allegran sold the patents for Restasis to the Awkwesasne-Mohawks to try to protect it with soverign immunity.
The US is a GDP ponzi scheme disguised as an economy. The silly prices exist to shuffle money between pharmaceutical companies, PBMs, insurers, pharmacies, hospitals, and who knows what other intermediaries. Everyone takes a cut and can put large revenues on their balance sheet.
The US today is structurally dependent on this sort of cash migration. If all Americans suddenly began to save 10%+ of their income every month (also structurally impossible for most), GDP would dramatically contract.
FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower.
Then the drug companies come in and offer a "savings card" which you apply at the pharmacy like another layer of insurance. I searched and Miebo has one too: https://miebo.blsavingscard.com/ You'd have to read all the fine print, but it reveals that the actual cash-pay price is $225 (still high, obviously) and they have a co-pay assistance program that reduces your copay to $0 to incentivize you to get your insurance billed for this drug. So a lot of people who take this drug in the US actually pay $0 because they sign up for this card.
The FDA is partially to blame for this situation: They required a complete New Drug Application before they would let anyone bring it to market, even though it's over the counter in other countries.
The cost of performing a New Drug Application starts in the mid hundreds of millions of dollars range and can extend into the billions for some drugs.
So nobody could feasibly introduce it to the market here without investing $500 million or more up front. At that price, your only viable option is to stick a big price tag on it and try to milk that money back from insurers.
These "savings cards" have a maximum annual benefit applied to them so for those on insurance that do not cover those expensive medications or who are self-paying use up the benefits before year end and do in fact eventually pay full sticker price.
I was on a blood thinner and the medication was very pricey. Didn't have insurance and the "savings card" covered fuck all unless you had insurance. There are three blood thinners on the US market and they all cost a lot.
If you don’t have insurance, you’re essentially fucked in the US but this thread is not referencing that situation. My CAT scan was billed for $10,000 but what I paid was about $200 with insurance. Without insurance I would owe $10k.
Depending on your situation, if non emergency and you were able to ask the cash price beforehand you might be surprised that you can get the same CT scan for less than what insurance ultimately paid. At least that’s my experience ($450 vs $1200). You may have to ask at a diagnostic imaging place, not the hospital since the hospitals can never tell you what anything costs they aren’t set up for it. (Of course I went through insurance since I didn’t want to pay out of pocket, but it was an interesting lesson in one of the reasons why healthcare is unnecessarily expensive in the US.)
Why stop the conversation here? And if you don't have insurance but go to an ER (can't be turned away) and end up getting some expensive procedure you can't afford, you can just tell them that you're broke and they negotiate way, way down, or even just forgive it. And it's setup like this to ensure only people who have proper full time jobs or who can write a good enough sob story can get care. Because so many of the people in charge of this mess are far more obsessed with blocking out people they can't get enough data on or who aren't working, then figuring out reasonable public prices that make some effort to strike some fair market balance. So that if you have some savings and aren't employed, you are forced to find any job with benefits so you aren't left bankrupt, which makes taking care of health struggles harder as you have to work instead of take care of yourself.
The insurance company is not a charity. You will (or already have) pay the full price.
> Without insurance I would owe $10k.
Without insurance you would be _billed_ $10k but in reality you likely end up paying less than that. It's still scandalous, mind you.
Then you switch to a difference card.
That's pretty much the entire business model of GoodRx.
> FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower.
Sure, we do not pay $800 at the pharmacy when we go to pick up the prescription, but every cent the insurance company pays, we are paying by proxie with added admin costs.
I think that might be worse than just having the high price. Such a kafka-esque systems just to get medicine.
The best thing about universal healthcare isn't how much money I may or may not have to pay, it's that I literally don't once have to think about a bill or filling out a form to avoid paying too much.
I wouldn't care if I ended up paying more in tax than I would in an insurance model. The benefit is being able to 100% focus on my health instead of navigating a system to try to reduce what I'm paying.
When you're diagnosed with an illness, that's a huge peace of mind.
Trust me it doesn’t work perfectly in other countries. Yes, americas system is messed up but in countries like Sweden you will still have to navigate the system to actually get the healthcare you need. There are people who are denied healthcare in Sweden because the govt has deemed that it’s too expensive to save them (while people with similar conditions and a good insurance in the US are covered).
> I wouldn't care if I ended up paying more in tax than I would
Here, in the US, you would be burned at the stake for heresy, for saying that.
One of the red-blooded American values, is that Taxes Are Bad, because rich people founded our country on a platform of Don't Tax Me, Limeys, and it has always been designed as a playground for wealth.
And yet, the average American pays more in taxes for public healthcare (medicare, medicaid) that they don't receive any of, than the average European pays in taxes for (some kind of) universal healthcare.
It's so bizarre seeing Americans in the debate not wanting "crazy high taxes like in Europe", because the US already spends twice as much public money per capita as the OECD average.
The dirty secret of course is that healthcare as a good is much more expensive to produce in the US than elsewhere, and a large chunk of that is because the private insurance system adds a ton of unnecessary overhead. And yet all the healthcare insurance companies in the US talk about making healthcare "affordable for all". Yeah, no, they're leeches. They're rent-seekers. They drive up the cost of everything.
The US has a massively progressive tax system. On a net tax basis about 50% of the country pays nothing. Sure, they pay sales tax and employment taxes, but they also receive some mix of earned income tax credits, child tax credits, snap, medicaid, housing, etc. There is no real way for the US to have a single payer tax system without more people actually becoming net tax payers.
Most countries have both public and private. In Spain I have public and then private on top of that which 220 eur a month for a family of four all services included and no co-pay. The public option works to set a roof on what private insurance can charge.
Absolutely. I'd prefer to go to the pharmacy and just pay my $20 and go.
That's usually how it works for me in the US. I go in to the pharmacy, and at least half the time they say 'no cost' and hand me my medication. Sometimes I pay a $25 copay. And if I get an expensive drug from Eli Lilly (e.g. Zepbound) then Eli Lilly pays Walgreens up to $1950/year on my behalf and I never even know about it. The only way I figured it out myself was trying to figure out why my insurance said they paid X, and I paid Y, but I had actually only paid $25. Took a trip onto a Zepbound subreddit to learn about the backdoor payment thing. "Savings card" but not actually a card.
Do you prefer sunny (Greece) or snowy (Norway)? You can just pay your $20 and go. It is an option.
I prefer to pay thousands in tariffs and/or private companies, thank you very much. I'm not a communist.
what about the poor people? the ones that can't really afford insurance. i've heard multiple times that epipen prices are crazy expensive and that's a really basic drug.
If you’re really poor, you can get Medicaid. It’s the working poor who earn too much for Medicaid who are really shafted. The ACA tried to fix that for as many as it could, by expanding Medicaid to households making more money; the Republicans shut down the government to fight that expansion. It’s maddening.
There's undoubtedly a significantly lower cash price if you don't have insurance (GP mentions $225). The before insurance prices are meaningless; they're a negotiating tactic between pharma companies and insurers.
I got my last Epi-Pen for free, since in my state Medicaid has no copay for prescriptions or else it's $2 or $3.
If you're poor you just wait until you're borderline dying and then go to the E.R. and get charged $120,000 and then never pay it and then have debt collectors calling you for the rest of your life.
Or you're on Medicaid if you live in a sane state.
Medicaid is available in all 50 states.
> The FDA is partially to blame for this situation: ...
> The cost of performing a New Drug Application starts in the mid hundreds of millions of dollars range and can extend into the billions for some drugs.
> So nobody could feasibly introduce it to the market here without investing $500 million or more up front. At that price, your only viable option is to stick a big price tag on it and try to milk that money back from insurers.
It's interesting that you seem so passionate about this because you're totally incorrect. The cost of a NDA for a novel prescription drug requiring clinical data (the most expensive application) is ~$4.5mil. In fact, the estimated TOTAL revenue to the FDA from ALL PD application fees in FY 2025 is ~$1.3billion (or, just under 300 novel prescription drugs). So, obviously, FDA fees can't be as much as you're claiming.
What you're actually describing is the total cost of the entire drug development pipeline (research, design, lab costs, chemical costs, application costs, marketing costs, etc.) to develop a brand new, novel drug. And it's only ~$200m, increasing to $500m if you include dead ends / failures in the process, and ~$900m if you include both failures and capital costs--yep, that's right the capital costs alone are almost as much as the entire rest of the drug development pipeline.
See: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
And that's for novel Prescription Drugs.
> They required a complete New Drug Application before they would let anyone bring it to market, even though it's over the counter in other countries.
No. In that case they would pay the FDA OMUFA fees, not the FDA PDUFA fees, which are ten to fifty times cheaper than the PDUFA fees.
> So a lot of people who take this drug in the US actually pay $0 because they sign up for this card.
They do not pay $0 because the insurance company raises the rates for all of their customers to cover the cost of all the red tape and time spent negotiating with drug companies over their bullshit. The insurance companies aren't eating those costs, they're profiting from them and it's us who end up footing the bill. By the time you factor in the unnecessary time, staff, record keeping, etc. the actual cost for the $20 drug will be even more than the $800 sticker price.
No matter how our crooked system twists things to make it look otherwise they always make you pay. One way or another.
Yep. And it's worse than that.
80% of prescriptions are controlled by 3 companies. You can look up the FTC report on it. All three of them own or are owned by insurance companies.
The insurance companies had their profit percentage capped, and so the only way they could increase profits was by increasing their share of the pie. So they bought medical providers and prescription companies.
Now the insurance company is both the buyer and the seller, but not the one who pays. We pay. So they raise the prices of the drug, raise the cost of insurance, and make a lot more money while staying in their profit percent cap.
All the way around, this is the opposite of a free market and the FTC should be breaking these companies up. And as everybody knows, all the way around, it is immoral, too.
All that handwaving and apology but yet
>the actual cash-pay price is $225
So still 11x the price, plus whatever the prescription costs.
Unforgiveable.
Well but that $225 feeds and clothes a lot of the people who spend all day designing these cards and systems around that
Including Oracle, probably.
The FDA bears much of the responsibility for that cost, which GP explained.
It's a very interesting drug. There are a lot of concerns right now around PFAS in water supplies, for example, and Miebo/Evotears are pure PFAS (perfluorohexyloctane) that's instilled directly in the eye, giving you a dose somewhere around a million times higher than levels of concern in drinking water.
But it is absolutely revolutionary if you have dry eyes. Quotes include "I feel like my eye is actually too wet now"
You could try this:
Visomitin (Emoxipine/Mexidol) eye drops are a Russian-developed antioxidant medication known for treating dry eyes, fatigue, radiation damage, and improving vision, working to protect eye cells from damage (oxidative stress), but it's not widely available or FDA-approved in the US, requiring international purchase or specific prescriptions, often used for cataracts or post-surgery recovery, focusing on cell protection rather than just lubrication like many Western OTC drops.
What the fuck... what's stopping this from poisoning our water supply?
The absolute miniscule volume
Pfas are measured in ppb or even ppt
Good thing there are 3*10^21 atoms of H2O in a water drop
Ok and there are around that many atoms of pfas per tear drop?
And water supply is measured in km^3
so 1 liter of eye drop per 1ppt of km^3
That would be 1 liter of the active ingredient, not 1 liter of the eye drop. Also I don't believe that 1 ppt of this stuff is harmful when people are putting it directly in their eyes without severe harm.
There's only a single ingredient, these eyedrops are 100% pure PFAS
And people put asbestos on their christmas trees back in the day - I don't think "obvious harm" is a high enough standard.
How many gallons of Miebo/Evotears do you think are manufactured every year?
Multiply that by the t in ppt. How many trillions of gallons of water do you think an average city uses every year?
Is all the Miebo/Evotears that’s manufactured being dumped directly into the drinking water supply?
Where do you think it goes after it gets to your eyes? The valid choices are:
A. Absorbed into your body forever.
B. Becomes a part of the water cycle.
C. Is broken down.
And even choice A eventually becomes choice B, ideally after significant time though.
How do you think pfas got into the water supply in the first place.
Largely firefighting foams, industrial and manufacturing, and landfill sources, but it's still an interesting problem. They don't really break down (that's why they're so useful both in a materials science sense and as a medication) which implies they'll stick around for an extremely long time.
Theoretically speaking how much would the components cost if one made it themselves? [1][2] My interests are purely academic as I have no need for this.
[1] - https://fourthievesvinegar.org/
[2] - https://www.youtube.com/watch?v=5rQklSmI_F0 [video][1hr16m][DEFCON 32]
According to another comment this product is pure 1-(perfluorohexyl)octane [1]. There's no practical way to make it at home, but if you buy it in bulk from an industrial supplier it can be had for $980-$750/kg, depending on how many kilograms you commit to buy at once:
https://www.chemicalbook.com/ProductDetail_EN_1-perfluorohex...
Add analytical lab services to analyze it for purity and you could still get a lifetime supply for the price of a couple of brand-name bottles. This is the sort of thing that some Americans have been doing to get cheap GLP-1 peptide drugs from overseas too.
[1] https://en.wikipedia.org/wiki/Perfluorohexyloctane
About 30 years in federal prison, probably.
"Before insurance" prices aren't real! The headline is misleading; the first sentence of the article is misleading. It drives me crazy. Most Americans absolutely do not understand how insurance works and journalists do their damnedest to keep it that way by constantly misleading them.
If a drug isn't one of the following it should be available over the counter.
1. heinously addictive
2. incredibly dangerous when not used exactly correctly
3. an antibiotic (due to the resistance externality)
And for drugs that do meet one of these conditions, doctors should be able to write lifetime prescriptions for cases where the medication is used to treat a permanent condition. This probably covers 95% of non-antibiotic prescriptions. The savings from removing the gatekeepers in terms of time and money would be massive and the costs would be minimal.
Then who would feed the gatekeepers?
How does it go?
"First, they came for the gatekeepers. Then, they came for the billionaires."
What a brave thing to say on a message board which thinks having a conversation with a chatbot should be illegal lest you ask it how to deal with emotions.
It’s very simple. In the US your pharmacy has a contract with the drug supplier that prevents the pharmacist from telling you that you could buy the drug without insurance for $10 while he charges you the $20 copay. As long as this is legal and your pharmacist’s duty isn’t to you the patient, don’t waste time worrying about the details.
We should in America should change our name to "The United States of Greed" and be done with it. There would be less confusion that way.
What's to stop congress from passing a blanket "most favored nation" law for VA + medicare on all pricing, inclusive of insurance rates and discounts? Seems like it would be fair and useful.
The US Congress doesn’t pass laws anymore. Let alone fair and useful ones.
The same thing that stops them from just joining the rest of the first world nations and giving us universal healthcare. Greed.
Trump already lowered costs of medicine by 1200%, what more do you want?
We're gonna be so rich!
>"most favored nation"
There is a weird thing Americans often do when confronted with the incredibly high price of medicine and medical care in the US of imagining that every other country is actually responsible for this (hence the "most favored" nonsense). That it's zero sum and every other country is laughing and taking Americans for a ride and underpaying, and therefore Americans have to cover the bill.
This is the angle Trump has taken in some of his incredibly ignorant and stupid screeds on this topic (as with every single position he has on anything): Get everyone else to pay more and somehow the US pays less!
This...isn't at all how it works, or what the problem is. Americans pay more because of the whole massive scam of your Medical Insurance Racket, where everything has imaginary inflated prices and an absolutely massive middle-tier of suits having nothing to do with medicine are taking their cut. This is your problem, reflected almost nowhere else on the planet, and it is domestic caused and will need to be fixed domestically. Criticizing Europe or Canada or anyone else will never, ever fix the utterly, insanely broken and profoundly stupid American system.
But it won't. It's simply incredibly how easily Americans can be fooled into voting against their own best interests, year after year.
The drug in question is perfluorohexyloctane, which is part of a class of substances known as PFAS or „forever chemical“. I‘m a chemist, I love modern medicine and material technologies based on chemistry, and I don’t hesitate to take vaccines or other meds, and I also happen to have SEVERE dry eyes syndrome - but hell no, I’m not going to put that stuff into nature!
If Americans didn't pay $800 for it, how would Europeans afford it?
</sarcasm>
Such an easily debunkable line with even the tiniest bit of critical thinking.
You’re basically saying the drug companies subsidise a loss in Europe by over charging Americans, right?
As the drug company is a private and doesn’t have to sell everywhere, why wouldn’t they just skip the loss making Europeans and just sell to Americans? They’d make more profit that way!
That must mean they make some profit from the European prices, otherwise they wouldn’t be bothering.
It's true in general, but not the reason this specific drug is more expensive here.
Chill dude. I added a </sarcasm> tag.
But to engage seriously:
> You’re basically saying the drug companies subsidise a loss in Europe by over charging Americans, right?
No - once they know how to manufacture a drug, it's dirt cheap for them to do so - they're still making a profit in Europe. The purpose of billing Americans a huge amount (other than they can get away with it), is to fund the research + trials for the next generation of drugs.
Of course, even this argument doesn't hold water. I remember when pharmaceuticals spent more on advertising/marketing than on R&D (may still be the case).
Drug costs are dominated by the fixed costs of development. $20/dose may very well cover the marginal cost of production while being far too little to make the overall venture profitable.
And Medicare cannot negotiate drug prices until 2026 (). Medicare is also banned from re-importing drugs from other countries (ex Canada) at lower prices. Thank you president GWB, the Alliance to Improve Medicare, and AARP (!!!!) https://pmc.ncbi.nlm.nih.gov/articles/PMC1126891/
() Biden's inflation act gave Medicare permission to start negotiating drug prices in 2026. Who know what the current US Administration will do though.
Nothing says capitalism and free market like good extortion on health products and services. That's the way to go USA.
There is no free market at play here. This is the result of FDA regulations not allowing anyone to sell it unless they did a New Drug Application first, which could cost a billion or more. Therefore nobody in the free market was allowed to sell it without putting up the capital first, which they have to collect back now.
You could actually order this from amazon.de up until recently and have it shipped to you. That seems to have disappeared, though.
Drugs and healthcare products should definitely be regulated so people get quality products with provable efficacy. Saying that, how the hell does an application for a new drug with the FDA cost $1Bn?! Clearly something is wrong there.
This is true. When you look at actually free markets -- like the gray markets in bodybuilding drugs, "nootropics," peptides, etc. -- you'll find that there's usually a race to the bottom on price, and that everything is easily affordable out of pocket. Quality also tends to be okay, as lab reports are one of the primary ways that customers rank and differentiate between brands.
And these aren't necessarily old pharma hand-me-downs. There are lots of novel and strange drugs (9-MBC, lol) that you can buy for next to nothing.
Where is a good place to start looking to access these gray markets?
peptidesciences.com among many others.
Are you saying a completely free market for drugs would be a good thing?
An NDA requires peer-reviewed studies, and something that looks at least a little like scientific rigour.
Of course we could just not bother with that.
Is that really a smart thing to do?
Require phase 1 only. That proves safety, but not efficacy. Require the companies to publicly release all data from their evaluations to the public. It's my right to decide on the risk / reward tradeoff, not some worthless bureaucrat to decide for me.
Free market is the $20 over the counter in Europe, not the USA way.
in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money.
in that case, you don't care if you drug cost 10€ or 2000€ because you aren't spending a single € from your own wallet, at least if you don't factor in taxes.
Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get it paid by their own insurance but it cost them directly a lot of money.
I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing. That's just how free market work, and technically there are many medication manufacturer and many customer.
Is it the proof that a true unregulated free market doesn't work ? if left unsupervised, big companies are going to buy smaller companies until they are monopoly or make secret, behind the door, deal to keep price up.
It's what the USA is made on, the idea of freedom and free market. i believe the idea of unregulated market is more recent, think the 70's, but surely in the 50 years since then american would have pushed back against it and not elected people like Trump who are all in.
Americans pay multiples more per capita, and receive worse healthcare based on outcomes compared to European nations. The UK on average has better oral health than the USA, but Americans love to joke about British teeth... I think the US believes it's own "free market" propaganda too much. Clearly socialised universal healthcare (which every G20 nation does outside the US) is a better system.
> I would think that americans would be much more vigilant about what medication they take
This is why I always check to make sure it's fiscally responsible before I start chemotherapy, or before buying that emergency inhaler for asthma, or before accepting paralytics and anesthesia when undergoing surgery. How fortunate that in America diabetics have the freedom to die rather than take overpriced insulin. Let the free market decide which child with leukemia deserves a bone marrow transplant and which deserves a casket! That's a much more responsible market than just having everybody chip in a small amount so that nobody needs to worry about the cost of the medications they need to live. Sure, in America millions will die or be bankrupted by healthcare costs every year, but that's better than spending a single $ from your own wallet if even a tiny fraction of it might help pay for someone else's medications right?
I mean you're joking but there are maybe ~20 brands who produce and sell inhalers. Maybe I need the inhaler but I also have a certain amount of choice, and presumably some are more expensive than others. Insulin is a famous example, because you can buy a vial for ~$30 or a nicer one for $300. They all effectively do the same thing but there is a quality difference between them, usually in regards to release time and how often you'd have to take it.
There are some market pressures in healthcare when multiple companies can compete, although it's so heavily regulated it can be hard to see the market pressures in practice. Consumers often do have some amount of choice though
> I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing.
> Is it the proof that a true unregulated free market doesn't work ?
The market is heavily regulated (frequently crazily) by the FDA, and the actual amount anything costs is heavily obscured from the eyes of any consumers by the fog of bureaucracy and insurance.
Many people have 3-4 tiers of fixed copays that the insurance company makes up - some pharmacies won't even tell you when there is a cash price or a "coupon" that would be cheaper than your insurance copay! And pharmacies don't publish a plain list of what the cash prices are, and it would be hard for most people to even produce the tier formulary, it's buried as a PDF in some obscure page of a horrible website. So we just go to the pharmacy and see what it'll cost us.
Also, one major insurer owns a major pharmacy benefits manager and one of the big 2 pharmacy chains, so they use that to put their thumb on the scale however they can, while the other insurers and PBMs play games to lock consumers into restrictive exclusive deals that are to their detriment.
Anyway we don't have a market at all when it comes to healthcare, because the majority of price information is withheld from consumers until the opportunity to make any choice, if it even existed, is well past.
> Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get it paid by their own insurance but it cost them directly a lot of money.
That's the idea, but in practice there are so many layers of indirect government incentives, disincentives, and direct interventions that market is no longer effective for this purpose.
It's virtually impossible to find out how much a medical procedure actually costs. Most hospitals and clinics refuse to even estimate as a policy, which has led to the creation of things like pre-paid services for labor and delivery. Those are quite rare.
I'm 100% in favor of allowing the market to work - but at this point, we have the worst of both worlds and the best of neither. Either extreme would be better than what we have.
The funny thing is that when you have one big customer (a country) - you get good prices.
When you have 30 insurance companies, 10000 companies buying insurance policies and millions of individuals - you get shit prices.
That's why the drug in question is 200 USD in US (after deductions) and 20 in Europe (including taxes).
Part of the problem is that the way our healthcare system is setup, it's not even a remotely free market. It's pretty much a worst of all worlds situation.
> I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing. That's just how free market work, and technically there are many medication manufacturer and many customer.
(Not american) This assumes they have a choice, no? Do these medications have real alternatives?
> in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money.
Europe is a big place, buddy. Which particular part are "we" from today?
NHS England has NICE (National Institute for Health and Care Excellence), which does the cost-benefit analysis for all medicines prescribed, nationally. It frequently decides medicines aren't worth the money. If you, as a private citizen, want that particular medicine, you can waste your own money on it. NHS England does not have a moral hazard problem.
The NHS also spends money trying to convince people to exercise, eat well, lose weight, not smoke, look for early signs of cancer, etc., because they find that relatively tiny amounts of money on these campaigns results in massive, massive savings from not having to treat so much preventable disease later in life.
i think healthcare is one market where capitalism just doesn't work well at all. for those areas, it actually makes sense to introduce hard or soft price ceilings.
> Contrary to the USA where it's a much more responsible market,
This is satire? I can’t tell anymore.
I mean the USA is the only country where someone can allegedly murder a healthcare executive for denying treatment and popular culture is engaged in drooling about how well the alleged killer fills out a tailored shirt.
What's the price on TrumpRx.gov?
out of curiosity, how much would this drug cost in Europe if they had required prescriptions as well
the article does a good job of showing the self serving double speak and the lack of pursuing an OTC option in the US, but I want to compare costs directly, since the article also acknowledges that OTC would have been much cheaper than $800 in the US too
Europe doesn't have a single health service. There are going to be different prices in different countries under different schemes.
In my EU country I get a subsidy of at least two thirds on most drug prices with a state prescription. But the nominal cost is already negotiated down by state purchasing, and I suspect there's some EU cooperation there. So it's impossible to say what the "normal" price would be.
The cost of the paperwork depends on your doctor. I pay €3 for new paperwork a few times a year.
You can get many drugs OTC here without a prescription - more expensive, but it always surprises tourists who suddenly discover they can get many common meds (except for things like antibiotics and steroids) just by asking.
Not a meaningful difference. I can't recall a time when I got prescription drugs in EU and had to pay a lot.
Why is it eye medication seems to be the market with the slimier moves? Sudden memories to when Allegran sold the patents for Restasis to the Awkwesasne-Mohawks to try to protect it with soverign immunity.
https://en.wikipedia.org/wiki/The_St._Regis_Mohawk_Tribe_and...
The US is a GDP ponzi scheme disguised as an economy. The silly prices exist to shuffle money between pharmaceutical companies, PBMs, insurers, pharmacies, hospitals, and who knows what other intermediaries. Everyone takes a cut and can put large revenues on their balance sheet.
The US today is structurally dependent on this sort of cash migration. If all Americans suddenly began to save 10%+ of their income every month (also structurally impossible for most), GDP would dramatically contract.
These things aren't broken. They are by design.