10 ms·

A $20 drug in Europe requires a prescription and $800 in the U.S.

259 points by geox 11mo ago

rational_human 11mo ago
[flagged]
jaggederest 11mo ago
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"
- wagwang 11mo ago
  What the fuck... what's stopping this from poisoning our water supply?
  - theMMaI 11mo ago
    The absolute miniscule volume
    - wagwang 11mo ago
      Pfas are measured in ppb or even ppt
      - terminalshort 11mo ago
        And water supply is measured in km^3
        wagwang 11mo ago
        so 1 liter of eye drop per 1ppt of km^3
        terminalshort 11mo ago
        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.
        jaggederest 11mo ago
        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.
        terminalshort 11mo ago
        I think obvious harm at 1 trillion parts per trillion is a pretty good standard to meet if you want to claim harm at 1 part per trillion.
        OutOfHere 11mo ago
        It's most definitely going to accumulate inside the body, although slowly.
        terminalshort 11mo ago
        Yes, but too slowly to matter. Average person consumes 1.5 liters per day of water, so if you live to 100 that's 55000 liters. At 1 ppt that's 1 ng / liter, or 55 ug over a lifetime. That's multiple orders of magnitude less than one drop of the stuff to your eye.
        OutOfHere 11mo ago
      - daedrdev 11mo ago
        Good thing there are 3*10^21 atoms of H2O in a water drop
        deleted 11mo ago
        [deleted]
        wagwang 11mo ago
        Ok and there are around that many atoms of pfas per tear drop?
        Aloisius 11mo ago
        PFAS are expressed as a mass fraction, not mole fraction.
    - autoexec 11mo ago
      How many gallons of Miebo/Evotears do you think are manufactured every year?
      - dotancohen 11mo ago
        Multiply that by the t in ppt. How many trillions of gallons of water do you think an average city uses every year?
        andy99 11mo ago
        Is all the Miebo/Evotears that’s manufactured being dumped directly into the drinking water supply?
        wagwang 11mo ago
        How do you think pfas got into the water supply in the first place.
        jaggederest 11mo ago
        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.
        dotancohen 11mo ago
        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.
        autoexec 11mo ago
        One thing you can be sure of is that the vats of PFAS being produced year after year for this drug aren't going away anytime soon. They're called "forever chemicals" for a reason.
  - cyberax 11mo ago
    Teflon is also PFAS. The whole PFAS scare is overblown.
    - OutOfHere 11mo ago
      > The whole PFAS scare is overblown. You have absolutely no idea of what you're talking about. If you actually think the scare is overblown, I dare you to drink the whole bottle of that eyedrop.
      - cyberax 11mo ago
        > You have absolutely no idea of what you're talking about. I do. 1. "PFAS" is a technically incorrect term. 2. It's ridiculously broad. Teflon is PFAS, sevoflurane is PFAS, and so on. > If you actually think the scare is overblown, I dare you to drink the whole bottle of that eyedrop. They literally use the same liquid to FILL THE EYEBALLS after retinal surgery. It's been approved for 25 years. A bottle of eyedrops has 4 milliliters of it, and it would do essentially nothing if swallowed.
        OutOfHere 11mo ago
        The only relevant subdivision of PFAS is by chain length: small, medium, large. Even so, they all accumulate in the environment. Just because you with your short term selfish interest doesn't take any responsibility for the world at large, willing to totally destroy it for small personal gain, does not mean that others don't either. All PFAS are very harmful in the environment because it's like paperclips that keep being made but not ever being unmade. Medium and long chain are also harmful in the human body due to significant accumulation. Teflon does not get a free pass. It is a toxin. The last I recall, it causes brain damage in children. There is a reason why sane people avoid nonstick cookware.
        cyberax 11mo ago
        > The only relevant subdivision of PFAS is by chain length: small, medium, large. PFOA and PFOS have 8-member fluorinated chains. And they are dangerous, with clear dose-dependent effects. PFHO has a 6-member fluorinated chain, and it has no known toxic effects. > Even so, they all accumulate in the environment. So does silicon oxide. Or a lot of other "terminal" compounds. The questions that need to be asked are: 1. Are they dangerous by themselves? 2. Do they bioaccumulate? 3. Do they stay mobile in the environment (i.e. don't get sequestered)? In case of PFHO, it's not dangerous. It does not bioaccumulate because of its poor absorption. And it's also not mobile. > The last I recall, it causes brain damage in children. No, it doesn't.
- Beijinger 11mo ago
  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.
  - autoexec 11mo ago
    > Visomitin (Emoxipine/Mexidol) eye drops are a Russian-developed antioxidant medication known for treating dry eyes, fatigue, radiation damage, and improving vision I wouldn't recommend it. A quick search shows that it's not proven to do anything at all but it's also advertised as being the cure for parkinson's, asthma, back pain, high cholesterol levels, anxiety, blood clots, glaucoma, and Huntington’s disease while also making you smarter and improving your memory. This sounds like classic snake oil. Something I'd expect to see being sold alongside Horny Goat Weed and kratom at a gas station rather than an actual medication dispensed by a pharmacist. As fucked up as the American healthcare system is I guess you really have to hand it to Russia sometimes.
    - OutOfHere 11mo ago
      I wouldn't be too sure or cocky because it does have a very broad mechanism of action that does cast a wide net. Humility is warranted.
      - autoexec 11mo ago
        I'd happily be proved wrong, but all the usual red flags are there. About the best that can be said for it at the moment is that there doesn't seem any more evidence that it's harmful than there is for it being helpful. Hopefully it gets the research to back up the claims. It certainly purports to be effective for conditions there's plenty of interest in developing effective and safe treatments for so you'd think that nations around the globe would be eager to look into it.
- OutOfHere 11mo ago
  Instead of putting and accumulating PFAS in your body, just get punctal cauterization. No drops will be needed thereafter.
  - cyberax 11mo ago
    I have punctal plugs. They helped quite a bit, but for most people with dry eyes it's the lack of the lipid layer that is causing problems. Not the lack of water.
    - OutOfHere 11mo ago
      Punctual plugs are not as great as cauterization for multiple reasons. Firstly, plugs keep dropping off and getting lost over time. Secondly, they probably won't seal the gap fully. The lipid emission will heal partially if one supplements vitamin A (10k IU) softgel, omega-3 triglyceride ester, taurine, and at least 4K IU of vitamin D3. It will heal enough to work. The D3 in this dose is for freezing autoimmune degeneration. I have severe dry eye and I never need any drops except if I am wearing contact lenses.
      - cyberax 11mo ago
        Before committing to plugs, I tried temporary plugs made of (essentially) collagen. They completely seal the tear ducts, and they were just as effective as my current plugs. And my plugs have been in place for 10 years so far. > The lipid emission will heal partially if one supplements vitamin A (10k IU) softgel, omega-3 triglyceride ester, taurine, and at least 4K IU of vitamin D3. It will heal enough to work. Omega-3 acids help a tiny bit, and I'm getting D3 and A from multivitamins. And I'm doing all other recommended stuff: eyelid washing, compresses, IPL, etc. Over the years, I tried discontinuing all of that a few times, and my symptoms worsened as a result. But not by much. PFHO is the most effective "artificial tears" type product. Nothing comes close to it.
        OutOfHere 11mo ago
        > PFHO Here we go again with the PFAS. It is the stuff to prefer the least, not the most. > I'm getting D3 and A from multivitamins That fails completely because they almost always don't have softgel oil-dissolve forms or the right dose at all. They're generally very far from it. It is exactly what leads to the autoimmune issue of dry eyes in the first place.
- cyberax 11mo ago
  It's also used to replace the intraocular fluid. In that case you'll get trillions times that. This is why the PFAS scare is quite a bit silly. "PFAS" is such a broad category that it's ridiculous.
  - ndsipa_pomu 11mo ago
    Surely the sheer number and amount of different PFAs being distributed around the planet without knowing about long term effects is the ridiculous bit. The argument that because we dump a lot of it must mean that it's safe is just wishful thinking. Remember when lead was added to fuel and large amounts of lead were then pumped into the air? It had very noticeable effects on criminality in people.
    - cyberax 11mo ago
      The question is in the amount of them. PFOA and PFOS were literally dumped in kiloton quantities into the environment without much thought about their toxicity. They were used in firefighting foam that was just flushed into the sewer. So yeah, removing that source of pollution is good. At the same time, the effects of even the worst offender (PFOS) are at most mild. Wildlife and epidemiological studies found significant effects only in areas that are at least billions of times more contaminated with PFAS than can ever accumulate in the environment if the waste streams are managed properly.
kotaKat 11mo ago
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_Restasis_patent https://en.wikipedia.org/wiki/The_St._Regis_Mohawk_Tribe_and...
ghostDancer 11mo ago
Nothing says capitalism and free market like good extortion on health products and services. That's the way to go USA.
- Aurornis 11mo ago
  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.
  - TheOtherHobbes 11mo ago
    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?
    - terminalshort 11mo ago
      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.
  - A_D_E_P_T 11mo ago
    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.
yieldcrv 11mo ago
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
- Insanity 11mo ago
  Not a meaningful difference. I can't recall a time when I got prescription drugs in EU and had to pay a lot.
- TheOtherHobbes 11mo ago
  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.
DarkmSparks 11mo ago
[flagged]
Aurornis 11mo ago
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/ 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.
- Insanity 11mo ago
  I think that might be worse than just having the high price. Such a kafka-esque systems just to get medicine.
  - timeon 11mo ago
    Probably not just medicine. I heard that prices in US shops are different than final price at the counter.
  - averageRoyalty 11mo ago
    Absolutely. I'd prefer to go to the pharmacy and just pay my $20 and go.
    - dotancohen 11mo ago
aucisson_masque 11mo ago
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.
- xp84 11mo ago
  > 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.
dominojab 11mo ago
[dead]
picafrost 11mo ago
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.
- deleted 11mo ago
  [deleted]
BeetleB 11mo ago
If Americans didn't pay $800 for it, how would Europeans afford it? </sarcasm>
- deleted 11mo ago
  [deleted]
- oakesm9 11mo ago
  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.
  - BeetleB 11mo ago
    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).
  - gensym 11mo ago
    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.
  - loeg 11mo ago
    It's true in general, but not the reason this specific drug is more expensive here.
  - 11mo ago
dh2022 11mo ago
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/ 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.
Schnitz 11mo ago
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.
- eszed 11mo ago
  I am grateful to every pharmacist / pharmacist assistent who's sotto voce ignored that immoral "rule". On the flip side, before I transferred my prescriptions to my (excellent) locally-owned small pharmacy, I checked that these are drugs on which the respective Pharmacy Benefits Manager allows them to make a profit rather than a loss. That reminds me that I'll need to repeat that conversation when our insurance changes in January.
- djoldman 11mo ago
  This has been illegal since 2018. I think you'll find that pharmacies have a book to show you every price if you ask. See S. 2554, the "Patient Right to Know Drug Prices Act"
philip1209 11mo ago
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.
- autoexec 11mo ago
  The same thing that stops them from just joining the rest of the first world nations and giving us universal healthcare. Greed.
  - rootusrootus 11mo ago
    We're working our way towards it little by little. We're up to ... around 40% on public healthcare now? Or thereabouts. Maybe the next dem president will write an executive order directing the HHS to drop the enrollment age for Medicare to zero.
  - nkmnz 11mo ago
    Or the metric system.
- dlisboa 11mo ago
  The US Congress doesn’t pass laws anymore. Let alone fair and useful ones.
- llm_nerd 11mo ago
  >"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.
Animats 11mo ago
What's the price on TrumpRx.gov?
terminalshort 11mo ago
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.
- dotancohen 11mo ago
  Then who would feed the gatekeepers?
  - actionfromafar 11mo ago
    How does it go? "First, they came for the gatekeepers. Then, they came for the billionaires."
- renewiltord 11mo ago
  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.
- brandonmenc 11mo ago
  We'd have to grant some form of blanket immunity to drug companies the way we currently do with vaccines. Also, aren't most mostly benign drugs dangerous when combined with the wrong other mostly benign drugs? The gatekeeping protects against that.
  - terminalshort 11mo ago
    Maybe sometimes, but a 5 second google search also protects against that 100% of the time. https://www.drugs.com/drug_interactions.html https://www.drugs.com/drug_interactions.html So I'd rather skip the gatekeepers.
Bender 11mo ago
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/ https://fourthievesvinegar.org/ [2] - https://www.youtube.com/watch?v=5rQklSmI_F0 https://www.youtube.com/watch?v=5rQklSmI_F0 [video][1hr16m][DEFCON 32]
- philipkglass 11mo ago
  According to another comment this product is pure 1-(perfluorohexyl)octane [1]. There's no practical way to make it at home, but it can be had for $980-$750/kg from an industrial supplier, depending on how many kilograms you commit to buy at once: https://www.chemicalbook.com/ProductDetail_EN_1-perfluorohexyloctane_2920929.htm 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 https://en.wikipedia.org/wiki/Perfluorohexyloctane
- actionfromafar 11mo ago
  About 30 years in federal prison, probably.
labrador 11mo ago
We in America should change our name to "The United States of Greed" and be done with it. There would be less confusion that way.
nkmnz 11mo ago
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!
- OutOfHere 11mo ago
  Precisely. Just because a medicine is an approved medicine increasingly shouldn't automatically mean that any sensible patient should ever use it. The PFAS in question is not even short chain, it is medium chain, which means it's likely to accumulate inside the body, albeit at a slow pace. One doesn't even have to be a chemist to know these things.
- cyberax 11mo ago
  The volumes in question are milliliters per month. And perfluorohexyloctane has been used in much larger quantities for intraocular fluid replacement for about 3 decades without negative side effects. The whole PFAS scare is waaaaay too overblown.
loeg 11mo ago
"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.
petercooper 11mo ago
However, it’s not all roses. Try getting melatonin in the UK. You can buy it almost anywhere in the US. Same for any first generation antihistamines. Or a jar of painkillers - packets are limited to 16 here. Or lidocaine cream. Whenever I go to the US, I have a shopping list to restock our medicine cabinet.
- Someone1234 11mo ago
  That's a very selective example. The US controls TONS of hormones, Melatonin just got grandfathered in. If anything the UK system is more self-consistent than the US, even if I think both systems over-protect hormones with a low risk profile (like Melatonin in the UK). As a counter-example, up until fairly recently you could buy Co-codamol (codeine, an opioid) in the UK off-the-shelf (i.e. no script). Which is a controlled substance. See how people can use selective examples to play the "one system good, one system bad" game?
  - petercooper 11mo ago
    I wasn’t playing a game, but if we must, you can buy jars of naproxen off the shelf in the US as well - prescription only here. And antibiotic ointment, antitussives, antibiotic eye drops, and benzocaine throat spray, just to pick what I see in our cabinet. I only share my own experience though, but I find US pharmacies to be streets ahead in both variety and depth. If other people have other experiences, that is fine and I believe them. One big benefit, though, is you can legally import or bring in POMs from overseas, a luxury the US does not have.
  - standardUser 11mo ago
    In terms of access to drugs, the differences between countries is incoherent, not really a "good vs bad" situation. A lot of it has to do with the different ways nations fumble their endless (yet fruitless) attempts to limit abuse and recreational use. But in terms of cost, the US system is bad. If we as a nation want to invest in drug development, we should do so. Instead we ask grandma and grandpa and the chronically ill to flip the bill. Hard to think of a worse approach.
  - 11mo ago
SilverElfin 11mo ago
I’m also surprised by the prescription gatekeepers in America. Many things are over the counter elsewhere.
quotemstr 11mo ago
Yeah, but in the US I can buy pseudoephedrine over the counter and the sky doesn't fall. Believe it or not French regulations, but there's no epidemic of strokes among sufferers of the common cold. Yes, the US system is broken in places, but at least it's a lot less boneheadedly paternalistic about availability of obviously safe drugs.
RoadieRoller 11mo ago
This ear drops solution, which is a general purpose ear drop for ear pain and irritation, can be bought over the counter in any medical shop and costs Rs. 15 in India (0.17USD). 7 years ago, when I last bought it, it was under Rs. 10 in India. https://www.1mg.com/drugs/ciplox-eye-ear-drops-197483?srsltid=AfmBOooL88GG9IMa9b23LET-TfEDiBCNlvydIzSSn659U5NaErZm97uh https://www.1mg.com/drugs/ciplox-eye-ear-drops-197483?srslti... The equivalent of the same in the US, I was told 200USD in the US using Insurance, and I bought it for 40USD via GoodRx App without Insurance. https://www.goodrx.com/ciprofloxacin https://www.goodrx.com/ciprofloxacin
bibimsz 11mo ago
our american version comes with 4000% more freedom
nyanmatt 11mo ago
Not only drug costs. I’m being charged 1300$ for an STD test because my insurance company and my doctor can’t agree on a “code”. It’s totally fucked.
tamimio 11mo ago
The whole medicine industry in North America needs an overhaul. Canada isn't better. The ER delays aren't because of anything but a (intentional?) convoluted process that causes them. Same with prescriptions. Why aren't pharmacists allowed to issue them? Why not even utilize AI (which is superior to any human when it comes to memorizing and correlating, both essential in diagnosis) and have a human to double check it just in case? The reason is obvious. It's lobbying and gatekeeping, from making it hard to become a doctor, to the pharmaceutical industry profits, insurance, among many others, to simply "monetize" every single step of the process and profit off people's misery.
purplepatrick 11mo ago
As someone mentioned already, list prices are completely fictitious. Their purpose is to anchor medical payers during reimbursement negotiations and satisfy PBMs (see below). The allowed price (the price that the payer pays to the drug company) is much, much lower, 70-90% or so in many cases. Thus, juxtaposing OTC and list price is not an apples-to-apples comparison. That being said, US drug prices are 2-4 times higher than they are elsewhere. In fact, the US market essentially subsidizes international drug markets, where it is much more difficult to charge higher rates due to regulations and lower purchasing power. This also means that, even if the allowed price in the US were known in this example, it would still have to be PPP adjusted to be compared. Prescription card coupons such as those you get from GoodRx et al apply only to cash prices. These are sometimes lower and sometimes higher than what you’d pay out of pocket with your insurance. to compare, you’d basically have to ask the pharmacy to ring up a drug twice, once with cash price + coupon and once with insurance price. “Copay assistance” are programs by drug manufacturers, PBMs, or employers to defray the cost of drug prices. This is usually done for specialty drugs that are much more expensive and can often only be purchased from a mail order pharmacy designated by the payer. For example, United Health (left pocket) will only cover the drugs if you get them from their Optum Specialty Pharmacy (right pocket). As for numbers, here an example: I’m receiving a monthly specialty drug that my insurance is billed ~$9,000/month. In order to arrive at that figure, the drug company proposed, say, a $50k/month list price, and my insurer countered with $9k, using the size of their member pool as leverage. Of course, the drug manufacturer knew they would arrive at approx that figure, which is why they started negotiating that high. Well, sorta. The PBM gets compensated based on a % of the “savings” (spread between list price and final price), so naturally, they want as high as possible a list price, because 5% of a big amount (in my example: $50k-$9k = $41k) than 5% of a smaller amount. Because the PBM often has most of the leverage, the drug manufacturers (most of whom actually dislike PBMs) have to go along with this stupidity. How much of the $9k I pay depends on a variety of factors, including my insurance plan, which has a specialty drug tier. This means the drug is not handled via the cost sharing accounting mechanism (deductible/copay). Now, through that specialty tier, my monthly responsibility is set at approx $1,300. I’m not privy to the math behind this, because my insurer has outsourced all drug-related administration to a PBM, which is only loosely regulated and doesn’t even have to issue explanation of benefit statements that would normally disclose the full accounting. Of the $1,300, I pay nothing, because the drug manufacturer provides me with a copay assistance card. Again, they must keep the list price high to placate the PBM. I’ve simplified a few things here. For instance, there are now alternative comp models for PBMs. But for those, PBMs have also found ways to manipulate the system in their favor (eg colluding with drug manufacturers). There’s also often a wholesaler involved in the “value” chain. But by and large, this is roughly how it works… And yes, individual market plans are substantially inferior. Not only do they have lower actuarial values and higher cost per $ of coverage (which is unavoidable, because they are not risk pools) and narrower networks, but they also usually have built-in mechanisms to further prune away coverage in many subtle ways (they have that in common with self-insured plans): - more prior approvals, - “step therapy” (must first not tolerate cheaper drugs before can receive pricier drug), - not covering the pricier drug tier at all, etc. These things shave some dollars off the premium, which appeals to price-elastic consumers and employers.
penguin_booze 11mo ago
Don't worry, soon the same drug will cost $900 in Europe. But hey, still cheaper than an iPhone.
rcbdev 11mo ago
There should be a civil war in the U.S. for this alone.

259 points by geox 11mo ago

[flagged]

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"

wagwang 11mo ago
What the fuck... what's stopping this from poisoning our water supply?
- theMMaI 11mo ago
  The absolute miniscule volume
  - wagwang 11mo ago
    Pfas are measured in ppb or even ppt
    - terminalshort 11mo ago
      And water supply is measured in km^3
      - wagwang 11mo ago
        so 1 liter of eye drop per 1ppt of km^3
        terminalshort 11mo ago
        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.
        jaggederest 11mo ago
        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.
        terminalshort 11mo ago
        I think obvious harm at 1 trillion parts per trillion is a pretty good standard to meet if you want to claim harm at 1 part per trillion.
        OutOfHere 11mo ago
        It's most definitely going to accumulate inside the body, although slowly.
        terminalshort 11mo ago
        Yes, but too slowly to matter. Average person consumes 1.5 liters per day of water, so if you live to 100 that's 55000 liters. At 1 ppt that's 1 ng / liter, or 55 ug over a lifetime. That's multiple orders of magnitude less than one drop of the stuff to your eye.
        OutOfHere 11mo ago
    - daedrdev 11mo ago
      Good thing there are 3*10^21 atoms of H2O in a water drop
      - deleted 11mo ago
        [deleted]
      - wagwang 11mo ago
        Ok and there are around that many atoms of pfas per tear drop?
      - Aloisius 11mo ago
        PFAS are expressed as a mass fraction, not mole fraction.
  - autoexec 11mo ago
    How many gallons of Miebo/Evotears do you think are manufactured every year?
    - dotancohen 11mo ago
      Multiply that by the t in ppt. How many trillions of gallons of water do you think an average city uses every year?
      - andy99 11mo ago
        Is all the Miebo/Evotears that’s manufactured being dumped directly into the drinking water supply?
        wagwang 11mo ago
        How do you think pfas got into the water supply in the first place.
        jaggederest 11mo ago
        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.
        dotancohen 11mo ago
        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.
        autoexec 11mo ago
        One thing you can be sure of is that the vats of PFAS being produced year after year for this drug aren't going away anytime soon. They're called "forever chemicals" for a reason.
- cyberax 11mo ago
  Teflon is also PFAS. The whole PFAS scare is overblown.
  - OutOfHere 11mo ago
    > The whole PFAS scare is overblown. You have absolutely no idea of what you're talking about. If you actually think the scare is overblown, I dare you to drink the whole bottle of that eyedrop.
    - cyberax 11mo ago
      > You have absolutely no idea of what you're talking about. I do. 1. "PFAS" is a technically incorrect term. 2. It's ridiculously broad. Teflon is PFAS, sevoflurane is PFAS, and so on. > If you actually think the scare is overblown, I dare you to drink the whole bottle of that eyedrop. They literally use the same liquid to FILL THE EYEBALLS after retinal surgery. It's been approved for 25 years. A bottle of eyedrops has 4 milliliters of it, and it would do essentially nothing if swallowed.
      - OutOfHere 11mo ago
        The only relevant subdivision of PFAS is by chain length: small, medium, large. Even so, they all accumulate in the environment. Just because you with your short term selfish interest doesn't take any responsibility for the world at large, willing to totally destroy it for small personal gain, does not mean that others don't either. All PFAS are very harmful in the environment because it's like paperclips that keep being made but not ever being unmade. Medium and long chain are also harmful in the human body due to significant accumulation. Teflon does not get a free pass. It is a toxin. The last I recall, it causes brain damage in children. There is a reason why sane people avoid nonstick cookware.
        cyberax 11mo ago
        > The only relevant subdivision of PFAS is by chain length: small, medium, large. PFOA and PFOS have 8-member fluorinated chains. And they are dangerous, with clear dose-dependent effects. PFHO has a 6-member fluorinated chain, and it has no known toxic effects. > Even so, they all accumulate in the environment. So does silicon oxide. Or a lot of other "terminal" compounds. The questions that need to be asked are: 1. Are they dangerous by themselves? 2. Do they bioaccumulate? 3. Do they stay mobile in the environment (i.e. don't get sequestered)? In case of PFHO, it's not dangerous. It does not bioaccumulate because of its poor absorption. And it's also not mobile. > The last I recall, it causes brain damage in children. No, it doesn't.
Beijinger 11mo ago
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.
- autoexec 11mo ago
  > Visomitin (Emoxipine/Mexidol) eye drops are a Russian-developed antioxidant medication known for treating dry eyes, fatigue, radiation damage, and improving vision I wouldn't recommend it. A quick search shows that it's not proven to do anything at all but it's also advertised as being the cure for parkinson's, asthma, back pain, high cholesterol levels, anxiety, blood clots, glaucoma, and Huntington’s disease while also making you smarter and improving your memory. This sounds like classic snake oil. Something I'd expect to see being sold alongside Horny Goat Weed and kratom at a gas station rather than an actual medication dispensed by a pharmacist. As fucked up as the American healthcare system is I guess you really have to hand it to Russia sometimes.
  - OutOfHere 11mo ago
    I wouldn't be too sure or cocky because it does have a very broad mechanism of action that does cast a wide net. Humility is warranted.
    - autoexec 11mo ago
      I'd happily be proved wrong, but all the usual red flags are there. About the best that can be said for it at the moment is that there doesn't seem any more evidence that it's harmful than there is for it being helpful. Hopefully it gets the research to back up the claims. It certainly purports to be effective for conditions there's plenty of interest in developing effective and safe treatments for so you'd think that nations around the globe would be eager to look into it.
OutOfHere 11mo ago
Instead of putting and accumulating PFAS in your body, just get punctal cauterization. No drops will be needed thereafter.
- cyberax 11mo ago
  I have punctal plugs. They helped quite a bit, but for most people with dry eyes it's the lack of the lipid layer that is causing problems. Not the lack of water.
  - OutOfHere 11mo ago
    Punctual plugs are not as great as cauterization for multiple reasons. Firstly, plugs keep dropping off and getting lost over time. Secondly, they probably won't seal the gap fully. The lipid emission will heal partially if one supplements vitamin A (10k IU) softgel, omega-3 triglyceride ester, taurine, and at least 4K IU of vitamin D3. It will heal enough to work. The D3 in this dose is for freezing autoimmune degeneration. I have severe dry eye and I never need any drops except if I am wearing contact lenses.
    - cyberax 11mo ago
      Before committing to plugs, I tried temporary plugs made of (essentially) collagen. They completely seal the tear ducts, and they were just as effective as my current plugs. And my plugs have been in place for 10 years so far. > The lipid emission will heal partially if one supplements vitamin A (10k IU) softgel, omega-3 triglyceride ester, taurine, and at least 4K IU of vitamin D3. It will heal enough to work. Omega-3 acids help a tiny bit, and I'm getting D3 and A from multivitamins. And I'm doing all other recommended stuff: eyelid washing, compresses, IPL, etc. Over the years, I tried discontinuing all of that a few times, and my symptoms worsened as a result. But not by much. PFHO is the most effective "artificial tears" type product. Nothing comes close to it.
      - OutOfHere 11mo ago
        > PFHO Here we go again with the PFAS. It is the stuff to prefer the least, not the most. > I'm getting D3 and A from multivitamins That fails completely because they almost always don't have softgel oil-dissolve forms or the right dose at all. They're generally very far from it. It is exactly what leads to the autoimmune issue of dry eyes in the first place.
cyberax 11mo ago
It's also used to replace the intraocular fluid. In that case you'll get trillions times that. This is why the PFAS scare is quite a bit silly. "PFAS" is such a broad category that it's ridiculous.
- ndsipa_pomu 11mo ago
  Surely the sheer number and amount of different PFAs being distributed around the planet without knowing about long term effects is the ridiculous bit. The argument that because we dump a lot of it must mean that it's safe is just wishful thinking. Remember when lead was added to fuel and large amounts of lead were then pumped into the air? It had very noticeable effects on criminality in people.
  - cyberax 11mo ago
    The question is in the amount of them. PFOA and PFOS were literally dumped in kiloton quantities into the environment without much thought about their toxicity. They were used in firefighting foam that was just flushed into the sewer. So yeah, removing that source of pollution is good. At the same time, the effects of even the worst offender (PFOS) are at most mild. Wildlife and epidemiological studies found significant effects only in areas that are at least billions of times more contaminated with PFAS than can ever accumulate in the environment if the waste streams are managed properly.

kotaKat 11mo ago

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_Restasis_patent https://en.wikipedia.org/wiki/The_St._Regis_Mohawk_Tribe_and...

ghostDancer 11mo ago

Nothing says capitalism and free market like good extortion on health products and services. That's the way to go USA.

Aurornis 11mo ago
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.
- TheOtherHobbes 11mo ago
  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?
  - terminalshort 11mo ago
    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.
- A_D_E_P_T 11mo ago
  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.

yieldcrv 11mo ago

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

Insanity 11mo ago
Not a meaningful difference. I can't recall a time when I got prescription drugs in EU and had to pay a lot.
TheOtherHobbes 11mo ago
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.

DarkmSparks 11mo ago

[flagged]

Aurornis 11mo ago

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/ 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.

Insanity 11mo ago
I think that might be worse than just having the high price. Such a kafka-esque systems just to get medicine.
- timeon 11mo ago
  Probably not just medicine. I heard that prices in US shops are different than final price at the counter.
- averageRoyalty 11mo ago
  Absolutely. I'd prefer to go to the pharmacy and just pay my $20 and go.
  - dotancohen 11mo ago

aucisson_masque 11mo ago

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.

xp84 11mo ago
> 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.

dominojab 11mo ago

[dead]

picafrost 11mo ago

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.

deleted 11mo ago
[deleted]

BeetleB 11mo ago

If Americans didn't pay $800 for it, how would Europeans afford it? </sarcasm>

deleted 11mo ago
[deleted]
oakesm9 11mo ago
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.
- BeetleB 11mo ago
  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).
- gensym 11mo ago
  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.
- loeg 11mo ago
  It's true in general, but not the reason this specific drug is more expensive here.
- 11mo ago

dh2022 11mo ago

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/ 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.

Schnitz 11mo ago

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.

eszed 11mo ago
I am grateful to every pharmacist / pharmacist assistent who's sotto voce ignored that immoral "rule". On the flip side, before I transferred my prescriptions to my (excellent) locally-owned small pharmacy, I checked that these are drugs on which the respective Pharmacy Benefits Manager allows them to make a profit rather than a loss. That reminds me that I'll need to repeat that conversation when our insurance changes in January.
djoldman 11mo ago
This has been illegal since 2018. I think you'll find that pharmacies have a book to show you every price if you ask. See S. 2554, the "Patient Right to Know Drug Prices Act"

philip1209 11mo ago

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.

autoexec 11mo ago
The same thing that stops them from just joining the rest of the first world nations and giving us universal healthcare. Greed.
- rootusrootus 11mo ago
  We're working our way towards it little by little. We're up to ... around 40% on public healthcare now? Or thereabouts. Maybe the next dem president will write an executive order directing the HHS to drop the enrollment age for Medicare to zero.
- nkmnz 11mo ago
  Or the metric system.
dlisboa 11mo ago
The US Congress doesn’t pass laws anymore. Let alone fair and useful ones.
llm_nerd 11mo ago
>"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.

Animats 11mo ago

What's the price on TrumpRx.gov?

terminalshort 11mo ago

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.

dotancohen 11mo ago
Then who would feed the gatekeepers?
- actionfromafar 11mo ago
  How does it go? "First, they came for the gatekeepers. Then, they came for the billionaires."
renewiltord 11mo ago
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.
brandonmenc 11mo ago
We'd have to grant some form of blanket immunity to drug companies the way we currently do with vaccines. Also, aren't most mostly benign drugs dangerous when combined with the wrong other mostly benign drugs? The gatekeeping protects against that.
- terminalshort 11mo ago
  Maybe sometimes, but a 5 second google search also protects against that 100% of the time. https://www.drugs.com/drug_interactions.html https://www.drugs.com/drug_interactions.html So I'd rather skip the gatekeepers.

Bender 11mo ago

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/ https://fourthievesvinegar.org/ [2] - https://www.youtube.com/watch?v=5rQklSmI_F0 https://www.youtube.com/watch?v=5rQklSmI_F0 [video][1hr16m][DEFCON 32]

philipkglass 11mo ago
According to another comment this product is pure 1-(perfluorohexyl)octane [1]. There's no practical way to make it at home, but it can be had for $980-$750/kg from an industrial supplier, depending on how many kilograms you commit to buy at once: https://www.chemicalbook.com/ProductDetail_EN_1-perfluorohexyloctane_2920929.htm 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 https://en.wikipedia.org/wiki/Perfluorohexyloctane
actionfromafar 11mo ago
About 30 years in federal prison, probably.

labrador 11mo ago

We in America should change our name to "The United States of Greed" and be done with it. There would be less confusion that way.

nkmnz 11mo ago

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!

OutOfHere 11mo ago
Precisely. Just because a medicine is an approved medicine increasingly shouldn't automatically mean that any sensible patient should ever use it. The PFAS in question is not even short chain, it is medium chain, which means it's likely to accumulate inside the body, albeit at a slow pace. One doesn't even have to be a chemist to know these things.
cyberax 11mo ago
The volumes in question are milliliters per month. And perfluorohexyloctane has been used in much larger quantities for intraocular fluid replacement for about 3 decades without negative side effects. The whole PFAS scare is waaaaay too overblown.

loeg 11mo ago

"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.

petercooper 11mo ago

However, it’s not all roses. Try getting melatonin in the UK. You can buy it almost anywhere in the US. Same for any first generation antihistamines. Or a jar of painkillers - packets are limited to 16 here. Or lidocaine cream. Whenever I go to the US, I have a shopping list to restock our medicine cabinet.

Someone1234 11mo ago
That's a very selective example. The US controls TONS of hormones, Melatonin just got grandfathered in. If anything the UK system is more self-consistent than the US, even if I think both systems over-protect hormones with a low risk profile (like Melatonin in the UK). As a counter-example, up until fairly recently you could buy Co-codamol (codeine, an opioid) in the UK off-the-shelf (i.e. no script). Which is a controlled substance. See how people can use selective examples to play the "one system good, one system bad" game?
- petercooper 11mo ago
  I wasn’t playing a game, but if we must, you can buy jars of naproxen off the shelf in the US as well - prescription only here. And antibiotic ointment, antitussives, antibiotic eye drops, and benzocaine throat spray, just to pick what I see in our cabinet. I only share my own experience though, but I find US pharmacies to be streets ahead in both variety and depth. If other people have other experiences, that is fine and I believe them. One big benefit, though, is you can legally import or bring in POMs from overseas, a luxury the US does not have.
- standardUser 11mo ago
  In terms of access to drugs, the differences between countries is incoherent, not really a "good vs bad" situation. A lot of it has to do with the different ways nations fumble their endless (yet fruitless) attempts to limit abuse and recreational use. But in terms of cost, the US system is bad. If we as a nation want to invest in drug development, we should do so. Instead we ask grandma and grandpa and the chronically ill to flip the bill. Hard to think of a worse approach.
- 11mo ago

SilverElfin 11mo ago

I’m also surprised by the prescription gatekeepers in America. Many things are over the counter elsewhere.

quotemstr 11mo ago

Yeah, but in the US I can buy pseudoephedrine over the counter and the sky doesn't fall. Believe it or not French regulations, but there's no epidemic of strokes among sufferers of the common cold. Yes, the US system is broken in places, but at least it's a lot less boneheadedly paternalistic about availability of obviously safe drugs.

RoadieRoller 11mo ago

This ear drops solution, which is a general purpose ear drop for ear pain and irritation, can be bought over the counter in any medical shop and costs Rs. 15 in India (0.17USD). 7 years ago, when I last bought it, it was under Rs. 10 in India. https://www.1mg.com/drugs/ciplox-eye-ear-drops-197483?srsltid=AfmBOooL88GG9IMa9b23LET-TfEDiBCNlvydIzSSn659U5NaErZm97uh https://www.1mg.com/drugs/ciplox-eye-ear-drops-197483?srslti... The equivalent of the same in the US, I was told 200USD in the US using Insurance, and I bought it for 40USD via GoodRx App without Insurance. https://www.goodrx.com/ciprofloxacin https://www.goodrx.com/ciprofloxacin

bibimsz 11mo ago

our american version comes with 4000% more freedom

nyanmatt 11mo ago

Not only drug costs. I’m being charged 1300$ for an STD test because my insurance company and my doctor can’t agree on a “code”. It’s totally fucked.

tamimio 11mo ago

The whole medicine industry in North America needs an overhaul. Canada isn't better. The ER delays aren't because of anything but a (intentional?) convoluted process that causes them. Same with prescriptions. Why aren't pharmacists allowed to issue them? Why not even utilize AI (which is superior to any human when it comes to memorizing and correlating, both essential in diagnosis) and have a human to double check it just in case? The reason is obvious. It's lobbying and gatekeeping, from making it hard to become a doctor, to the pharmaceutical industry profits, insurance, among many others, to simply "monetize" every single step of the process and profit off people's misery.

purplepatrick 11mo ago

As someone mentioned already, list prices are completely fictitious. Their purpose is to anchor medical payers during reimbursement negotiations and satisfy PBMs (see below). The allowed price (the price that the payer pays to the drug company) is much, much lower, 70-90% or so in many cases. Thus, juxtaposing OTC and list price is not an apples-to-apples comparison. That being said, US drug prices are 2-4 times higher than they are elsewhere. In fact, the US market essentially subsidizes international drug markets, where it is much more difficult to charge higher rates due to regulations and lower purchasing power. This also means that, even if the allowed price in the US were known in this example, it would still have to be PPP adjusted to be compared. Prescription card coupons such as those you get from GoodRx et al apply only to cash prices. These are sometimes lower and sometimes higher than what you’d pay out of pocket with your insurance. to compare, you’d basically have to ask the pharmacy to ring up a drug twice, once with cash price + coupon and once with insurance price. “Copay assistance” are programs by drug manufacturers, PBMs, or employers to defray the cost of drug prices. This is usually done for specialty drugs that are much more expensive and can often only be purchased from a mail order pharmacy designated by the payer. For example, United Health (left pocket) will only cover the drugs if you get them from their Optum Specialty Pharmacy (right pocket). As for numbers, here an example: I’m receiving a monthly specialty drug that my insurance is billed ~$9,000/month. In order to arrive at that figure, the drug company proposed, say, a $50k/month list price, and my insurer countered with $9k, using the size of their member pool as leverage. Of course, the drug manufacturer knew they would arrive at approx that figure, which is why they started negotiating that high. Well, sorta. The PBM gets compensated based on a % of the “savings” (spread between list price and final price), so naturally, they want as high as possible a list price, because 5% of a big amount (in my example: $50k-$9k = $41k) than 5% of a smaller amount. Because the PBM often has most of the leverage, the drug manufacturers (most of whom actually dislike PBMs) have to go along with this stupidity. How much of the $9k I pay depends on a variety of factors, including my insurance plan, which has a specialty drug tier. This means the drug is not handled via the cost sharing accounting mechanism (deductible/copay). Now, through that specialty tier, my monthly responsibility is set at approx $1,300. I’m not privy to the math behind this, because my insurer has outsourced all drug-related administration to a PBM, which is only loosely regulated and doesn’t even have to issue explanation of benefit statements that would normally disclose the full accounting. Of the $1,300, I pay nothing, because the drug manufacturer provides me with a copay assistance card. Again, they must keep the list price high to placate the PBM. I’ve simplified a few things here. For instance, there are now alternative comp models for PBMs. But for those, PBMs have also found ways to manipulate the system in their favor (eg colluding with drug manufacturers). There’s also often a wholesaler involved in the “value” chain. But by and large, this is roughly how it works… And yes, individual market plans are substantially inferior. Not only do they have lower actuarial values and higher cost per $ of coverage (which is unavoidable, because they are not risk pools) and narrower networks, but they also usually have built-in mechanisms to further prune away coverage in many subtle ways (they have that in common with self-insured plans): - more prior approvals, - “step therapy” (must first not tolerate cheaper drugs before can receive pricier drug), - not covering the pricier drug tier at all, etc. These things shave some dollars off the premium, which appeals to price-elastic consumers and employers.

penguin_booze 11mo ago

Don't worry, soon the same drug will cost $900 in Europe. But hey, still cheaper than an iPhone.

rcbdev 11mo ago

There should be a civil war in the U.S. for this alone.