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.
> 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.
This isn't really true on obamacare/ACA plans, even the high-end ones like gold PPOs. The formularies are much worse than employer-based plans. Insurers are required to cover one drug in each therapeutic category, but its usually an older generic. Most brand name drugs like this one have really bad coverage or not at all, which means the insurer won't even negotiate with the pharmacy to lower the drug.
Yes you can use coupons, sometimes, but the pharmacy can't always process them and the manufacture is always change the conditions and expiring them. I got one for my glaucoma drops directly from my eye doctor, and it was expired immediately when I tried to use it. I have paid $650 (for a 3 month supply, the full retail cost) for my drops when the coupon didn't work, and I couldn't get them any other way - I can't interrupt the med or else my eyes get damaged. So that falsifies your "nobody" assertion.
Anyone know what's going on with the ACA marketplace?
I like to take a peek at it every so often and it's just stupendously worse than employer healthcare. There is no plan in my market (Idaho) which doesn't have extreme out of network deductibles. The cost is also identical to what I and my employer pay for insurance.
Is it just that the ACA is mostly used by sick people or something?
For one thing, as I understand it, the ACA was pretty effectively sabotaged by removing the mandate, which destroys the math that makes insurance work.
Because pre-existing conditions have to be covered, you're free to wait until you have a serious (expensive) condition, then sign up for an ACA plan. And there's no mandate that spreads that risk around to healthy people, so the population is severely skewed.
I have no definitive data on this, but it seems self-evident that the system can't work well.
As a solo dev, I’ve been on ACA with my family for the past four years. In my market, a major insurance company is not returning for 2026 and the prices have gone bananas. Our premiums are increasing over 40%, all of our copays are more than doubling, and the deductible is astronomical. In many cases the cash pay price is probably cheaper than the insurance negotiated rate.
I’m the plus side, all bronze plans can contribute to HSAs next year.
We compared individual plans off market, but they’re mostly the same without HSA access or they’re targeting people with specific ailments (e.g. the diabetes plan).
On top of that, consolidation of hospital systems has made wait times for GPs months unless you’re lucky enough to find a cancelation. We have some older Canadian ex-pat friends and it seems like our health system has all of the downsides of socialized systems, plus we get to pay Cadillac prices.
I’m really hoping 2026 is so bad that something breaks enough to resolve some fundamental issues with private health costs, but I’m not naive enough to think it’s likely. ACA was such a monumental gift to someone, but it definitely not individuals who need family coverage.
It's because health insurance companies need to pad their profits. Because we have a backward system in the US where profits are extracted by everyone without any competition from a not-for-profit. That's why the idea of a public option is so popular (it was originally a Republican idea until it was decided insurance company profits are more desirable). Personally, I don't think any health insurance company should be for-profit. But the for-profit companies sure as hell should have a non-profit competition with the same bargaining power they do.
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.
Warfarin needs blood tests at least every 2 or 3 weeks. I bet those tests are not cheap in the USA. Furthermore you can't have any food with significant amounts of vitamine K or its precursors. There are pills that cost more but don't require any of that. And actually they cost very little or zero, at least in my European country. Prescription only, of course.
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.
Was $10k before or after the insurance negotiated discount? Pre-discount prices mean nothing: I had the same tests ordered twice (needed the results urgently), once through my PCP/HMO and once paid to a walk-in doctor's office in cash. The cash price was $700. My PCP claimed a price of insurance $3500, who then negotiated it down to a "discounted" $710. So the worst of both worlds would have been a high deductible plan.
The way you have those loopholes and you have to watch out for them else you're on the hook for thousands of dollars is nuts. I mean, sure, you _might_ get a good deal or you might get completely screwed. This is absolutely not normal or fair. A society of gotcha's induces a lot of inefficiency. And as much as the US sometimes rails against inefficiency, it seems it's only a problem when you're not used to it.
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.
This won’t work too well for most stuff. They don’t have to treat anything you present with, and don’t have to fully treat even e.g. a heart attack. They just have to stabilize you. So they can turn you away under most medical circumstances. Like you’re not going to get free chemo or (non-emergency) prenatal care or what have you. They also can triage you into the “maybe in twelve hours… maybe” group until you go away if you don’t seem like you’re dying, or likely to pay.
It’s priced that way because Medicare has to get the best price by law. Everyone else gets a lessor discount, with cash payers getting nothing by default.
It makes sense - the largest payer should get the best price. But it doesn’t make sense because it’s not really a market.
We’d have much better outcomes with a Medicare for all model, and then private insurance could actually be priced with an insurance model and be used as a fringe benefit again.
Im 41 and haven't been to a doctor since I was 10. I have had insurance coverage my whole life. So technically I (my employer on my behalf I guess) have paid for many other people's services.
I have been a huge net positive for insurance companies. Other people get way more services than they ever paid.
Nobody in my family has any kind of crazy chronic conditions. A few surgeries, a couple of c-sections, a week in the NICU, a few short stays in some hospitals. We've experienced nearly half a million in healthcare benefits from our insurance companies over the years. I don't think I'm ever going to pay enough in premiums to cover these costs.
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.)
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).
Also inflexibility, large backlogs, quality of staff, etc.
In Canada all of our best doctors go to the US and there's often nurse shortages. It's not just a private incentive either, the US gov pays out far more in public healthcare coverage as a percentage of GDP and per capita than Canada and almost all of Europe.
Despite their reputation the US doesn't have a lack of public healthcare spending (ranking #1-3 in the world). It's just their system's insurance regulation is extremely convoluted, creating risky edge-cases and perverse incentives. If they fixed that they would by far have the best healthcare system in the world.
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.
> The public option works to set a roof on what private insurance can charge.
Exactly! This is what no one in the US seems to understand. My encounters with private clinics and hospitals in the UK (all 10+ years ago, at this point) were unbelievably luxurious, at prices that (totally, completely free-market driven, mind you) were affordable on middle-class incomes. Or, yeah: there's private medical insurance, also free-marketed to "shockingly reasonable", by US measures. Americans on good salaries have been bamboozled into believing that a single-payer system will trap them into some kind of hell-hole hospital° with no recourse, when in fact the exact opposite is true.
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°And, of course, the "hell-hole hospital" examples are cherry-picked. Bad on their own, of course, but not representative of a system as a whole, nor recognize that equally awful anecdotes are abundant in the USA.
Right, and in my country you can even mix and match it.
I went to see my GP, paid for by public health, they referred me to a specialist.
I chose to pay €100 to see a private doctor who was available sooner (the next day) and had better ratings.
They referred me for an MRI which was done at another private provider, paid for by public health.
I went back to the private doctor and paid for a non-surgical treatment, which wasn't available on public health.
If that doesn't work, later I can opt for surgery, paid for by public health.
And even more importantly: There is one system that tracks all diagnoses, treatment, medication etc used by both public and private healthcare providers, so medical history is available instantly to everyone.
Unfortunately a lot of us do understand this, but our representatives (who definitely know this) don't care or are actively opposed to making improvements other than reducing taxes (which hurts more than helps, IMO).
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.
It's more efficient to allocate capital to systems and processes that delay or stop you claiming on your insurance than it is to actually pay out a genuine claim.
> 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.
This varies wildly by medication; and makes a ton of assumptions that all happen to benefit the drug company's position/parrots their PR.
For example, my partner needs $100/pill medication, which also had a "savings card." That card only lasts for 12-months or 8-pills (whichever comes first). Then it is $100/pill. After insurance (High Deductible), we pay out of pocket $100/pill up until $3200. Insurance discount: 0%.
So the cash price and the insurance price are identical, except the insurance price counts towards deductible. UK price of the same medication? £10/pill, and that isn't via the NHS, that is full-price private (NHS could be as low as FREE, depending on several factors).
> 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.
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.
Gov shutdown wasn’t about medicaid expansion, which is done at the state level. It was about expanding ACA subsidies to those making more than 400% of the federal poverty level.
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.
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.
> 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"
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.
Maybe, maybe not, maybe like teflon, the real poison is an intermediate ingredient, but I think its bullshit that we're just creating chemicals that linger in our water supply for eternity. You literally cannot find anyone in America without traces of the dangerous variant of the PFAS in their blood stream. Like every sip of water is some ridiculous dupont cocktail and we have to tolerate it because people have dry eyes and want non stick pans. Why cant you just use theratears?
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.
We will know after the drops have been out for over a decade, and actual real-world safety data studies get published.
Meanwhile, Restasis (cyclosporine A) (or a generic) works well, and doesn't have to be applied all day long, just two or three times a day. It does burn the eye initially, but it's not harmful, and the burning goes slowly away over time. It does take a few months to start working.
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.
Being dispersed in the environment is not the same as being concentrated into our drinking water supply with each measure resulting in 1ppt contamination of a trillion measures of water.
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.
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.
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.
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.
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.
> 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.
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.
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?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
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.
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.
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 it can be had for $980-$750/kg from an industrial supplier, 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.
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.
You can get larger packs of painkillers OTC by speaking with a pharmacist (OTC in the literal sense) or ordering online. For example, Boots sells a 96 count 400mg ibuprofen.
> Whenever I go to the US, I have a shopping list to restock our medicine cabinet
Ha, that's funny, I do something kind of like that when I go to the UK. Though it's just one medicine -- Kwells. Easily available OTC there, not available at all here in the US except as a prescription-only transdermal patch.
Aha! I have heard Americans say they buy Buscopan for IBS when in the Uk as it’s not available at all in the US and it has the same active ingredient! I had no idea it was good for nausea too.
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?
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.
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.
I save my shopping list for Puerto Vallarta where I'll buy a small amount of benzos instead of battling it out with a US doctor for a prescription. But don't try that in Guadalajara - it's in the same state but the restrictions are far stricter.
And if you're a fan of Benadryl (diphenhydramine), don't expect to buy it in Latin America. It virtually doesn't exist.
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.
This exists throughout government procurement and it is part of the reason list prices are so high.
The overhead of selling to the government is significantly higher than selling to private companies. So the government simultaneously demands the lowest price while having a much higher cost of sales that needs to be covered by that price. A price that would cover the cost of selling to the government would be non-competitive if selling it to a private company because you may be competing with other companies that don't have to anchor their prices to the cost of doing business with the government.
To work around this companies post a very high list price, no lower than what they charge the government as required by MFN regulations. They then effectively steeply discount those prices when selling to other entities via various mechanisms to more accurately reflect the lower cost of sales. The list price is a fiction required to satisfy "most favored nation" pricing laws, no one is expected to pay it.
tl;dr: In many cases the basic economics requires the government to be charged more than average because they are expensive customers with high overhead. MFN regulations don't make this reality go away so companies have to creatively structure their pricing to satisfy regulations without requiring non-government customers to pay for government overhead.
"Most favored nation" is to the Trump addled brain like sugar water to a bee. It sounds vaguely like "Go USA" while having nothing to do with the actual problem at hand. Just wait for those 400% 500% price reductions to kick in then. The problem is the fuckup that is your domestic healthcare market, not anything to do with international trade.
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.
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.
"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.
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!
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.
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.
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 a bit more complicated than that. R&D for new drugs is incredibly expensive while the cost to actually produce most drugs is reasonably low.
The price of drugs that make it to market needs to not only cover the cost to produce the drug, but also the cost of R&D and the cost of R&D of all the drugs that fail to get to market.
Now this gets complicated when a company sells in different markets with actors that have different negotiating power. It makes sense to sell in any market where the company can get a profit per unit sold without including R&D. But if none of the markets allow enough profit to cover R&D, then it's not really worth developing any new drugs at all anymore.
That's why people say that the US is basically subsidizing drug development. It's not that it's not profitable to sell in the rest of the world, it's just that margins are much lower which allows for a lot less risk-taking on R&D.
> 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.
Drug companies net profit margin is 2x that of a typical company. EU and America have equal size populations.
Back of envelope, if the total cost of that drug went solely to profit, and profits were cut in half, it would cost $200 for both Europeans and Americans if we paid the same price.
So yeah, we are kind of subsidizing the lower prices for Europe.
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.
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.
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.
> There are lots of novel and strange drugs (9-MBC, lol) that you can buy for next to nothing
Indeed, plenty of peptides that aren't really well tested in humans (in some cases, like at all). And some that have tests in foreign countries but are not recognized by the FDA (like Selank and Semax, which are nootropics). And if you want to get ahead of the curve, you can buy things like retatrutide already even though it hasn't quite completed Phase III tests yet so Lilly isn't able to sell it to you. If you hunt a little, you can even buy orforglipron now.
It is quite fascinating to watch. A lot of people are very willing to experiment on themselves. And it seems like GLP1s end up being a gateway drug -- people go to the gray market to get it cheap, and then they cave to temptation and try some of the other stuff they can get the same way.
That's not true, most of the gray markets you have to be careful with the quality of the product. Also, there are regulations on Europe, like with insulin but in USA is much more expensive than in Europe.
An easy, somewhat expensive (if you do not know the trick) entry point that is easily accessible to anyone is nexaph.com. You can pay full retail (quite expensive) or go to their Telegram (listed at the bottom of their page) and wait for a pre-sale, where it'll be a little above half the price on the web page.
Still more expensive than the rest of the random Chinese vendors, but the upshot is that participation rates are very good for Nexaph and so there's a lot of testing done -- especially for GLP1s. For example, the current batch of Tirzepatide 60mg will have a 3- or 4-vial COA done by Nexaph themselves, another 3-vial random sample tested by customers (but then compensated by Nexaph), and at least one and maybe two big group tests with 7+ vials doing a full range of mass/purity/endo/sterility testing.
I've not seen too many other vendors that get such a high participation rate. And even for this company, for non-GLP1 peptides it's still tested pretty well but not to the same extent.
Even at their expensive price point, you could buy a few kits (10 vials ea) and pay $1000 for a full suite of tests and still be into it about $80/vial total, where a vial is ~65mg and lasts most people at least a month. Do the math on that -- compared even to cheap compounded tirz it is a fraction of the cost. There is good reason why a lot of people are taking that route now.
And back to your original question - once you are on the Telegram group, ask around and people will invite you to other Telegram and Discord groups for various vendors.
Or go to glp1forum.com and a lot of the same vendors will have posts there with information on contacting them.
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.
I costs $1 billion because the FDA requires an enormously expensive 3 phase trial program before you are even allowed to submit the application. There is no way to make this cheaper without relaxing the requirements.
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.
I know, the problem with drugs in USA is the control a few corporations have over the politicians and the market, that's the reason health care and all related things are so expensive there compared to Europe.
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.
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.
> 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.
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.
You're painting with a fairly broad brush. Opinions in the US are diverse, and generally more in support of socialized healthcare than against.
We're not far from half the US population having what amounts to universal healthcare already, even without making it official. I sometimes wonder how high it will get before people come to the realization that we're already close enough to that point and going the rest of the way is viable.
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.
It does not work that way, though, because as a practical matter, the majority of routine medications in the US are generics now and quite cheap, maybe $25 out of pocket (and frequently zero) with even basic insurance. The crazy prices happen for the edge cases. Things that happen often enough that you may know someone affected by it, but are still a minority of most people's experience.
> 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.
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.
> 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.
This isn't really true on obamacare/ACA plans, even the high-end ones like gold PPOs. The formularies are much worse than employer-based plans. Insurers are required to cover one drug in each therapeutic category, but its usually an older generic. Most brand name drugs like this one have really bad coverage or not at all, which means the insurer won't even negotiate with the pharmacy to lower the drug.
Yes you can use coupons, sometimes, but the pharmacy can't always process them and the manufacture is always change the conditions and expiring them. I got one for my glaucoma drops directly from my eye doctor, and it was expired immediately when I tried to use it. I have paid $650 (for a 3 month supply, the full retail cost) for my drops when the coupon didn't work, and I couldn't get them any other way - I can't interrupt the med or else my eyes get damaged. So that falsifies your "nobody" assertion.
Anyone know what's going on with the ACA marketplace?
I like to take a peek at it every so often and it's just stupendously worse than employer healthcare. There is no plan in my market (Idaho) which doesn't have extreme out of network deductibles. The cost is also identical to what I and my employer pay for insurance.
Is it just that the ACA is mostly used by sick people or something?
For one thing, as I understand it, the ACA was pretty effectively sabotaged by removing the mandate, which destroys the math that makes insurance work.
Because pre-existing conditions have to be covered, you're free to wait until you have a serious (expensive) condition, then sign up for an ACA plan. And there's no mandate that spreads that risk around to healthy people, so the population is severely skewed.
I have no definitive data on this, but it seems self-evident that the system can't work well.
As a solo dev, I’ve been on ACA with my family for the past four years. In my market, a major insurance company is not returning for 2026 and the prices have gone bananas. Our premiums are increasing over 40%, all of our copays are more than doubling, and the deductible is astronomical. In many cases the cash pay price is probably cheaper than the insurance negotiated rate.
I’m the plus side, all bronze plans can contribute to HSAs next year.
We compared individual plans off market, but they’re mostly the same without HSA access or they’re targeting people with specific ailments (e.g. the diabetes plan).
On top of that, consolidation of hospital systems has made wait times for GPs months unless you’re lucky enough to find a cancelation. We have some older Canadian ex-pat friends and it seems like our health system has all of the downsides of socialized systems, plus we get to pay Cadillac prices.
I’m really hoping 2026 is so bad that something breaks enough to resolve some fundamental issues with private health costs, but I’m not naive enough to think it’s likely. ACA was such a monumental gift to someone, but it definitely not individuals who need family coverage.
I’ve used ACA plans off and on for about a decade. They’ve mostly been as good (of not better) than the employer plans we had once or twice.
So my guess is this is heavily state dependent. Maryland as a state isn’t hostile to ACA so I think they have solid plans.
I can also only speak for BlueCross plans.
Prices have jumped, see:
Many people that use the Marketplace plans don't have employer sponsored health plans available.
It's because health insurance companies need to pad their profits. Because we have a backward system in the US where profits are extracted by everyone without any competition from a not-for-profit. That's why the idea of a public option is so popular (it was originally a Republican idea until it was decided insurance company profits are more desirable). Personally, I don't think any health insurance company should be for-profit. But the for-profit companies sure as hell should have a non-profit competition with the same bargaining power they do.
Pretty sure Kaiser Permanente is not-for-profit, many Blue Cross Blue Shield members are non-profit
> Because we have a backward system in the US where profits are extracted by everyone without any competition from a not-for-profit.
California has an excellent non-profit option, and it depresses prices a bit, but not a huge amount
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.
> There are three blood thinners on the US market and they all cost a lot.
What about Warfarin? Its $21 for 30 pills, according to https://www.goodrx.com/warfarin
Warfarin needs blood tests at least every 2 or 3 weeks. I bet those tests are not cheap in the USA. Furthermore you can't have any food with significant amounts of vitamine K or its precursors. There are pills that cost more but don't require any of that. And actually they cost very little or zero, at least in my European country. Prescription only, of course.
>I bet those tests are not cheap in the USA.
Within 5 minutes of searching I found a PT time with INR test for $24 [0]. Add in the testing fee and it's probably around $30.
[0] https://www.ultalabtests.com/test/prothrombin-time-with-inr-...
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.
Was $10k before or after the insurance negotiated discount? Pre-discount prices mean nothing: I had the same tests ordered twice (needed the results urgently), once through my PCP/HMO and once paid to a walk-in doctor's office in cash. The cash price was $700. My PCP claimed a price of insurance $3500, who then negotiated it down to a "discounted" $710. So the worst of both worlds would have been a high deductible plan.
The way you have those loopholes and you have to watch out for them else you're on the hook for thousands of dollars is nuts. I mean, sure, you _might_ get a good deal or you might get completely screwed. This is absolutely not normal or fair. A society of gotcha's induces a lot of inefficiency. And as much as the US sometimes rails against inefficiency, it seems it's only a problem when you're not used to it.
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.
> go to an ER (can't be turned away)
This won’t work too well for most stuff. They don’t have to treat anything you present with, and don’t have to fully treat even e.g. a heart attack. They just have to stabilize you. So they can turn you away under most medical circumstances. Like you’re not going to get free chemo or (non-emergency) prenatal care or what have you. They also can triage you into the “maybe in twelve hours… maybe” group until you go away if you don’t seem like you’re dying, or likely to pay.
It’s priced that way because Medicare has to get the best price by law. Everyone else gets a lessor discount, with cash payers getting nothing by default.
It makes sense - the largest payer should get the best price. But it doesn’t make sense because it’s not really a market.
We’d have much better outcomes with a Medicare for all model, and then private insurance could actually be priced with an insurance model and be used as a fringe benefit again.
> 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.
The insurance company is not a charity. You will (or already have) pay the full price.
Im 41 and haven't been to a doctor since I was 10. I have had insurance coverage my whole life. So technically I (my employer on my behalf I guess) have paid for many other people's services. I have been a huge net positive for insurance companies. Other people get way more services than they ever paid.
Not necessarily; your costs are pooled with others like any other insurance. Some will pay more over time, others less.
Nobody in my family has any kind of crazy chronic conditions. A few surgeries, a couple of c-sections, a week in the NICU, a few short stays in some hospitals. We've experienced nearly half a million in healthcare benefits from our insurance companies over the years. I don't think I'm ever going to pay enough in premiums to cover these costs.
Lucky them... Having the privilege to... checks notes be sick.
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.)
Then you switch to a difference card.
That's pretty much the entire business model of GoodRx.
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).
Also inflexibility, large backlogs, quality of staff, etc.
In Canada all of our best doctors go to the US and there's often nurse shortages. It's not just a private incentive either, the US gov pays out far more in public healthcare coverage as a percentage of GDP and per capita than Canada and almost all of Europe.
Despite their reputation the US doesn't have a lack of public healthcare spending (ranking #1-3 in the world). It's just their system's insurance regulation is extremely convoluted, creating risky edge-cases and perverse incentives. If they fixed that they would by far have the best healthcare system in the world.
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.
> The public option works to set a roof on what private insurance can charge.
Exactly! This is what no one in the US seems to understand. My encounters with private clinics and hospitals in the UK (all 10+ years ago, at this point) were unbelievably luxurious, at prices that (totally, completely free-market driven, mind you) were affordable on middle-class incomes. Or, yeah: there's private medical insurance, also free-marketed to "shockingly reasonable", by US measures. Americans on good salaries have been bamboozled into believing that a single-payer system will trap them into some kind of hell-hole hospital° with no recourse, when in fact the exact opposite is true.
---
°And, of course, the "hell-hole hospital" examples are cherry-picked. Bad on their own, of course, but not representative of a system as a whole, nor recognize that equally awful anecdotes are abundant in the USA.
Right, and in my country you can even mix and match it.
I went to see my GP, paid for by public health, they referred me to a specialist.
I chose to pay €100 to see a private doctor who was available sooner (the next day) and had better ratings.
They referred me for an MRI which was done at another private provider, paid for by public health.
I went back to the private doctor and paid for a non-surgical treatment, which wasn't available on public health.
If that doesn't work, later I can opt for surgery, paid for by public health.
And even more importantly: There is one system that tracks all diagnoses, treatment, medication etc used by both public and private healthcare providers, so medical history is available instantly to everyone.
Unfortunately a lot of us do understand this, but our representatives (who definitely know this) don't care or are actively opposed to making improvements other than reducing taxes (which hurts more than helps, IMO).
In many countries where "universal healthcare" actually exists, you end up with waiting lists and rationed care. Choose your poison.
The US also has "waiting lists and rationed care".
Absolutely. I'd prefer to go to the pharmacy and just pay my $20 and go.
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.
Sir, your visa application is denied anyways.
Yes Sir Mr President Sir.
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.
It's the efficiency of capitalism at work.
It's more efficient to allocate capital to systems and processes that delay or stop you claiming on your insurance than it is to actually pay out a genuine claim.
Probably not just medicine. I heard that prices in US shops are different than final price at the counter.
> 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.
This varies wildly by medication; and makes a ton of assumptions that all happen to benefit the drug company's position/parrots their PR.
For example, my partner needs $100/pill medication, which also had a "savings card." That card only lasts for 12-months or 8-pills (whichever comes first). Then it is $100/pill. After insurance (High Deductible), we pay out of pocket $100/pill up until $3200. Insurance discount: 0%.
So the cash price and the insurance price are identical, except the insurance price counts towards deductible. UK price of the same medication? £10/pill, and that isn't via the NHS, that is full-price private (NHS could be as low as FREE, depending on several factors).
> 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.
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.
Gov shutdown wasn’t about medicaid expansion, which is done at the state level. It was about expanding ACA subsidies to those making more than 400% of the federal poverty level.
If you're really poor you end up going to the emergency room and get a $20k bill that you never end up paying
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.
It is not available to all poor people in all states
https://www.cbpp.org/research/health/the-medicaid-coverage-g...
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.
The real question is: how much does the drug cost, independent of who pays for it?
I know people who have paid list prices for drugs because their insurance wouldn’t cover them.
> 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.
Not true. No one pays up front, our previous pay for those prices.
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"
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
PFAS are expressed as a mass fraction, not mole fraction.
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.
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.
Maybe, maybe not, maybe like teflon, the real poison is an intermediate ingredient, but I think its bullshit that we're just creating chemicals that linger in our water supply for eternity. You literally cannot find anyone in America without traces of the dangerous variant of the PFAS in their blood stream. Like every sip of water is some ridiculous dupont cocktail and we have to tolerate it because people have dry eyes and want non stick pans. Why cant you just use theratears?
> You literally cannot find anyone in America without traces of the dangerous variant of the PFAS in their blood stream.
You also can't find anybody in the world without traces of lead, arsenic, uranium, radium, and other chemical elements in their blood.
> Why cant you just use theratears?
Because they don't work.
It's most definitely going to accumulate inside the body, although slowly.
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.
We will know after the drops have been out for over a decade, and actual real-world safety data studies get published.
Meanwhile, Restasis (cyclosporine A) (or a generic) works well, and doesn't have to be applied all day long, just two or three times a day. It does burn the eye initially, but it's not harmful, and the burning goes slowly away over time. It does take a few months to start working.
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.
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.
Being dispersed in the environment is not the same as being concentrated into our drinking water supply with each measure resulting in 1ppt contamination of a trillion measures of water.
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.
Teflon is also PFAS. The whole PFAS scare is overblown.
> 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.
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.
Instead of putting and accumulating PFAS in your body, just get punctal cauterization. No drops will be needed thereafter.
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.
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.
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.
> 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.
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."
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.
Maybe sometimes, but a 5 second google search also protects against that 100% of the time. https://www.drugs.com/drug_interactions.html So I'd rather skip the gatekeepers.
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.
Before pearl clutching about individual abuse of antibiotics, let’s go after factory farms abusing them at scale.
I should be allowed to buy front line antibiotics from the grocery store. It’s infuriating that this is not possible..
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?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
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.
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"
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.
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 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-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.
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.
You can get larger packs of painkillers OTC by speaking with a pharmacist (OTC in the literal sense) or ordering online. For example, Boots sells a 96 count 400mg ibuprofen.
https://www.boots.com/boots-ibuprofen-caplets-400mg-96s-1026...
> Whenever I go to the US, I have a shopping list to restock our medicine cabinet
Ha, that's funny, I do something kind of like that when I go to the UK. Though it's just one medicine -- Kwells. Easily available OTC there, not available at all here in the US except as a prescription-only transdermal patch.
Aha! I have heard Americans say they buy Buscopan for IBS when in the Uk as it’s not available at all in the US and it has the same active ingredient! I had no idea it was good for nausea too.
+1
This is the "exception that proves the rule" I guess
One of the best OTC medicine for motion sickeness hand down
Dramamine is (almost literally) a bad joke
What's the deal with Dramamine? It's pushed everywhere but it has zero effect on me, I even tried 4 pills at once, nothing at all
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?
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.
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.
I save my shopping list for Puerto Vallarta where I'll buy a small amount of benzos instead of battling it out with a US doctor for a prescription. But don't try that in Guadalajara - it's in the same state but the restrictions are far stricter.
And if you're a fan of Benadryl (diphenhydramine), don't expect to buy it in Latin America. It virtually doesn't exist.
> Try getting melatonin in the UK.
Maybe in UK but I had not problem with that on the actual continent.
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.
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.
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.
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.
Or the metric system.
This exists throughout government procurement and it is part of the reason list prices are so high.
The overhead of selling to the government is significantly higher than selling to private companies. So the government simultaneously demands the lowest price while having a much higher cost of sales that needs to be covered by that price. A price that would cover the cost of selling to the government would be non-competitive if selling it to a private company because you may be competing with other companies that don't have to anchor their prices to the cost of doing business with the government.
To work around this companies post a very high list price, no lower than what they charge the government as required by MFN regulations. They then effectively steeply discount those prices when selling to other entities via various mechanisms to more accurately reflect the lower cost of sales. The list price is a fiction required to satisfy "most favored nation" pricing laws, no one is expected to pay it.
tl;dr: In many cases the basic economics requires the government to be charged more than average because they are expensive customers with high overhead. MFN regulations don't make this reality go away so companies have to creatively structure their pricing to satisfy regulations without requiring non-government customers to pay for government overhead.
Trump already lowered costs of medicine by 1200%, what more do you want?
We're gonna be so rich!
"Most favored nation" is to the Trump addled brain like sugar water to a bee. It sounds vaguely like "Go USA" while having nothing to do with the actual problem at hand. Just wait for those 400% 500% price reductions to kick in then. The problem is the fuckup that is your domestic healthcare market, not anything to do with international trade.
>"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.
our american version comes with 4000% more freedom
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.
"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.
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!
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.
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.
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 a bit more complicated than that. R&D for new drugs is incredibly expensive while the cost to actually produce most drugs is reasonably low.
The price of drugs that make it to market needs to not only cover the cost to produce the drug, but also the cost of R&D and the cost of R&D of all the drugs that fail to get to market.
Now this gets complicated when a company sells in different markets with actors that have different negotiating power. It makes sense to sell in any market where the company can get a profit per unit sold without including R&D. But if none of the markets allow enough profit to cover R&D, then it's not really worth developing any new drugs at all anymore.
That's why people say that the US is basically subsidizing drug development. It's not that it's not profitable to sell in the rest of the world, it's just that margins are much lower which allows for a lot less risk-taking on R&D.
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).
> why wouldn’t they just skip the loss making Europeans and just sell to Americans?
this argument is easily dismissible for any product that has high fixed costs but low marginal costs
which applies to a lot of drugs
It's true in general, but not the reason this specific drug is more expensive here.
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.
Drug companies net profit margin is 2x that of a typical company. EU and America have equal size populations.
Back of envelope, if the total cost of that drug went solely to profit, and profits were cut in half, it would cost $200 for both Europeans and Americans if we paid the same price.
So yeah, we are kind of subsidizing the lower prices for Europe.
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.
I’m also surprised by the prescription gatekeepers in America. Many things are over the counter elsewhere.
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.
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.
> There are lots of novel and strange drugs (9-MBC, lol) that you can buy for next to nothing
Indeed, plenty of peptides that aren't really well tested in humans (in some cases, like at all). And some that have tests in foreign countries but are not recognized by the FDA (like Selank and Semax, which are nootropics). And if you want to get ahead of the curve, you can buy things like retatrutide already even though it hasn't quite completed Phase III tests yet so Lilly isn't able to sell it to you. If you hunt a little, you can even buy orforglipron now.
It is quite fascinating to watch. A lot of people are very willing to experiment on themselves. And it seems like GLP1s end up being a gateway drug -- people go to the gray market to get it cheap, and then they cave to temptation and try some of the other stuff they can get the same way.
That's not true, most of the gray markets you have to be careful with the quality of the product. Also, there are regulations on Europe, like with insulin but in USA is much more expensive than in Europe.
Where is a good place to start looking to access these gray markets?
An easy, somewhat expensive (if you do not know the trick) entry point that is easily accessible to anyone is nexaph.com. You can pay full retail (quite expensive) or go to their Telegram (listed at the bottom of their page) and wait for a pre-sale, where it'll be a little above half the price on the web page.
Still more expensive than the rest of the random Chinese vendors, but the upshot is that participation rates are very good for Nexaph and so there's a lot of testing done -- especially for GLP1s. For example, the current batch of Tirzepatide 60mg will have a 3- or 4-vial COA done by Nexaph themselves, another 3-vial random sample tested by customers (but then compensated by Nexaph), and at least one and maybe two big group tests with 7+ vials doing a full range of mass/purity/endo/sterility testing.
I've not seen too many other vendors that get such a high participation rate. And even for this company, for non-GLP1 peptides it's still tested pretty well but not to the same extent.
Even at their expensive price point, you could buy a few kits (10 vials ea) and pay $1000 for a full suite of tests and still be into it about $80/vial total, where a vial is ~65mg and lasts most people at least a month. Do the math on that -- compared even to cheap compounded tirz it is a fraction of the cost. There is good reason why a lot of people are taking that route now.
And back to your original question - once you are on the Telegram group, ask around and people will invite you to other Telegram and Discord groups for various vendors.
Or go to glp1forum.com and a lot of the same vendors will have posts there with information on contacting them.
peptidesciences.com among many others.
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.
I costs $1 billion because the FDA requires an enormously expensive 3 phase trial program before you are even allowed to submit the application. There is no way to make this cheaper without relaxing the requirements.
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.
I know, the problem with drugs in USA is the control a few corporations have over the politicians and the market, that's the reason health care and all related things are so expensive there compared to Europe.
I doubt it. The company probably would make more money selling it at 20 bucks at CVS to anyone who wants it than $800 per prescription.
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.
What's the price on TrumpRx.gov?
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...
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.
> 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.
FDA’s regulations are basically unrelated to the healthcare system and what makes American healthcare so expensive.
GP is right that monopolization and vertical integration (as you allude to in your comment) is much more salient.
The FDA is not only related to it, but quite central. The main expense in drug development is getting through the FDA approval process.
> 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).
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.
You're painting with a fairly broad brush. Opinions in the US are diverse, and generally more in support of socialized healthcare than against.
We're not far from half the US population having what amounts to universal healthcare already, even without making it official. I sometimes wonder how high it will get before people come to the realization that we're already close enough to that point and going the rest of the way is viable.
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.
It does not work that way, though, because as a practical matter, the majority of routine medications in the US are generics now and quite cheap, maybe $25 out of pocket (and frequently zero) with even basic insurance. The crazy prices happen for the edge cases. Things that happen often enough that you may know someone affected by it, but are still a minority of most people's experience.
> 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.
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.