[HN Gopher] A $20 drug in Europe requires a prescription and $80...
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       A $20 drug in Europe requires a prescription and $800 in the U.S.
        
       Author : geox
       Score  : 103 points
       Date   : 2025-12-05 21:27 UTC (1 hours ago)
        
 (HTM) web link (www.statnews.com)
 (TXT) w3m dump (www.statnews.com)
        
       | jaggederest wrote:
       | It's a very interesting drug. There are a lot of concerns right
       | now around PFAS in water supplies, for example, and
       | Miebo/Evotears are pure PFAS (perfluorohexyloctane) that's
       | instilled directly in the eye, giving you a dose somewhere around
       | a million times higher than levels of concern in drinking water.
       | 
       | But it is absolutely revolutionary if you have dry eyes. Quotes
       | include "I feel like my eye is actually too wet now"
        
         | wagwang wrote:
         | What the fuck... what's stopping this from poisoning our water
         | supply?
        
           | theMMaI wrote:
           | The absolute miniscule volume
        
             | wagwang wrote:
             | Pfas are measured in ppb or even ppt
        
               | terminalshort wrote:
               | And water supply is measured in km^3
        
               | wagwang wrote:
               | so 1 liter of eye drop per 1ppt of km^3
        
               | terminalshort wrote:
               | 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.
        
               | daedrdev wrote:
               | Good thing there are 3*10^21 atoms of H2O in a water drop
        
               | wagwang wrote:
               | Ok and there are around that many atoms of pfas per tear
               | drop?
        
             | autoexec wrote:
             | How many gallons of Miebo/Evotears do you think are
             | manufactured every year?
        
               | dotancohen wrote:
               | Multiply that by the t in ppt. How many trillions of
               | gallons of water do you think an average city uses every
               | year?
        
               | andy99 wrote:
               | Is all the Miebo/Evotears that's manufactured being
               | dumped directly into the drinking water supply?
        
               | wagwang wrote:
               | How do you think pfas got into the water supply in the
               | first place.
        
         | Beijinger wrote:
         | 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.
        
       | kotaKat wrote:
       | 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...
        
       | ghostDancer wrote:
       | Nothing says capitalism and free market like good extortion on
       | health products and services. That's the way to go USA.
        
         | Aurornis wrote:
         | There is no free market at play here. This is the result of FDA
         | regulations not allowing anyone to sell it unless they did a
         | New Drug Application first, which could cost a billion or more.
         | Therefore nobody in the free market was allowed to sell it
         | without putting up the capital first, which they have to
         | collect back now.
         | 
         | You could actually order this from amazon.de up until recently
         | and have it shipped to you. That seems to have disappeared,
         | though.
        
           | TheOtherHobbes wrote:
           | Are you saying a completely free market for drugs would be a
           | good thing?
           | 
           | An NDA requires peer-reviewed studies, and something that
           | looks at least a little like scientific rigour.
           | 
           | Of course we could just not bother with that.
           | 
           | Is that _really_ a smart thing to do?
        
             | terminalshort wrote:
             | Require phase 1 only. That proves safety, but not efficacy.
             | Require the companies to publicly release all data from
             | their evaluations to the public. It's my right to decide on
             | the risk / reward tradeoff, not some worthless bureaucrat
             | to decide for me.
        
           | A_D_E_P_T wrote:
           | 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.
        
             | terminalshort wrote:
             | Where is a good place to start looking to access these gray
             | markets?
        
               | A_D_E_P_T wrote:
               | peptidesciences.com among many others.
        
         | terminalshort wrote:
         | Free market is the $20 over the counter in Europe, not the USA
         | way.
        
       | yieldcrv wrote:
       | out of curiosity, how much would this drug cost in Europe if they
       | had required prescriptions as well
       | 
       | the article does a good job of showing the self serving double
       | speak and the lack of pursuing an OTC option in the US, but I
       | want to compare costs directly, since the article also
       | acknowledges that OTC would have been much cheaper than $800 in
       | the US too
        
         | Insanity wrote:
         | Not a meaningful difference. I can't recall a time when I got
         | prescription drugs in EU and had to pay a lot.
        
         | TheOtherHobbes wrote:
         | 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 EUR3
         | 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.
        
       | Aurornis wrote:
       | 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.
        
         | Insanity wrote:
         | I think that might be worse than just having the high price.
         | Such a kafka-esque systems just to get medicine.
        
           | averageRoyalty wrote:
           | Absolutely. I'd prefer to go to the pharmacy and just pay my
           | $20 and go.
        
             | dotancohen wrote:
             | Do you prefer sunny (Greece) or snowy (Norway)? You can
             | just pay your $20 and go. It is an option.
        
               | actionfromafar wrote:
               | I prefer to pay thousands in tariffs and/or private
               | companies, thank you very much. I'm not a communist.
        
           | xnorswap wrote:
           | 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.
        
             | ChrisMarshallNY wrote:
             | _> I wouldn 't care if I ended up paying more in tax than I
             | would_
             | 
             | Here, in the US, you would be burned at the stake for
             | heresy, for saying that.
             | 
             | One of the red-blooded American values, is that Taxes Are
             | Bad, because rich people founded our country on a platform
             | of _Don 't Tax Me, Limeys_, and it has always been designed
             | as a playground for wealth.
        
               | wang_li wrote:
               | The US has a massively progressive tax system. On a net
               | tax basis about 50% of the country pays nothing. Sure,
               | they pay sales tax and employment taxes, but they also
               | receive some mix of earned income tax credits, child tax
               | credits, snap, medicaid, housing, etc. There is no real
               | way for the US to have a single payer tax system without
               | more people actually becoming net tax payers.
        
               | henrikschroder wrote:
               | And yet, the average American pays more in taxes for
               | public healthcare (medicare, medicaid) that they don't
               | receive any of, than the average European pays in taxes
               | for (some kind of) universal healthcare.
               | 
               | It's so bizarre seeing Americans in the debate not
               | wanting "crazy high taxes like in Europe", because the US
               | already spends twice as much public money per capita as
               | the OECD average.
               | 
               | The dirty secret of course is that healthcare as a good
               | is much more expensive to produce in the US than
               | elsewhere, and a large chunk of that is because the
               | private insurance system adds a ton of unnecessary
               | overhead. And yet all the healthcare insurance companies
               | in the US talk about making healthcare "affordable for
               | all". Yeah, no, they're leeches. They're rent-seekers.
               | They drive up the cost of _everything_.
        
             | christkv wrote:
             | 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.
        
             | victorbjorklund wrote:
             | 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).
        
         | ThePowerOfFuet wrote:
         | 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.
        
           | yread wrote:
           | Well but that $225 feeds and clothes a lot of the people who
           | spend all day designing these cards and systems around that
        
             | actionfromafar wrote:
             | Including Oracle, probably.
        
         | brianherbert wrote:
         | 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.
        
           | Ancapistani wrote:
           | Then you switch to a difference card.
           | 
           | That's pretty much the entire business model of GoodRx.
        
           | khannn wrote:
           | 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.
        
             | dyauspitr wrote:
             | 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.
        
               | maccard wrote:
               | > 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.
        
               | hnuser123456 wrote:
               | 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.
        
         | autoexec wrote:
         | > 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.
        
           | jtbayly wrote:
           | 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.
        
         | zuppy wrote:
         | 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.
        
           | ksenzee wrote:
           | 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.
        
           | yunwal wrote:
           | 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.
        
             | trollbridge wrote:
             | Medicaid is available in all 50 states.
        
           | trollbridge wrote:
           | 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.
        
         | sov wrote:
         | > 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.
        
       | aucisson_masque wrote:
       | 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 10EUR or 2000EUR
       | because you aren't spending a single EUR from your own wallet, at
       | least if you don't factor in taxes.
       | 
       | Contrary to the USA where it's a much more responsible market,
       | people do pay for the medications or they get it paid by their
       | own insurance but it cost them directly a lot of money.
       | 
       | I would think that americans would be much more vigilant about
       | what medication they take, the price it cost, and so would have
       | much lower pricing. That's just how free market work, and
       | technically there are many medication manufacturer and many
       | customer.
       | 
       | Is it the proof that a true unregulated free market doesn't work
       | ? if left unsupervised, big companies are going to buy smaller
       | companies until they are monopoly or make secret, behind the
       | door, deal to keep price up.
       | 
       | It's what the USA is made on, the idea of freedom and free
       | market. i believe the idea of unregulated market is more recent,
       | think the 70's, but surely in the 50 years since then american
       | would have pushed back against it and not elected people like
       | Trump who are all in.
        
         | xp84 wrote:
         | > 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.
        
         | thrwwXZTYE wrote:
         | 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).
        
         | DangitBobby wrote:
         | 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.
        
         | Ancapistani wrote:
         | > 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.
        
         | amiga386 wrote:
         | > 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.
        
         | heathrow83829 wrote:
         | 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.
        
         | SkiFire13 wrote:
         | > 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?
        
         | autoexec wrote:
         | > 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,
         | but that's better than spending a single EUR from your own
         | wallet if a tiny fraction of it might pay for someone else's
         | medications right?
        
           | guywithahat wrote:
           | 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
        
         | exasperaited wrote:
         | > 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.
        
       | picafrost wrote:
       | 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.
        
         | thomassmith65 wrote:
         | Good God, they have played us for fools! Everyone grab your
         | pitchfork! /s
        
       | BeetleB wrote:
       | If Americans didn't pay $800 for it, how would Europeans afford
       | it?
       | 
       | </sarcasm>
        
         | oakesm9 wrote:
         | Such an easily debunkable line with even the tiniest bit of
         | critical thinking.
         | 
         | You're basically saying the drug companies subsidise a loss in
         | Europe by over charging Americans, right?
         | 
         | As the drug company is a private and doesn't have to sell
         | everywhere, why wouldn't they just skip the loss making
         | Europeans and just sell to Americans? They'd make more profit
         | that way!
         | 
         | That must mean they make some profit from the European prices,
         | otherwise they wouldn't be bothering.
        
           | BeetleB wrote:
           | Chill dude. I added a </sarcasm> tag.
           | 
           | But to engage seriously:
           | 
           | > You're basically saying the drug companies subsidise a loss
           | in Europe by over charging Americans, right?
           | 
           | No - once they know how to manufacture a drug, it's dirt
           | cheap for them to do so - they're still making a profit in
           | Europe. The purpose of billing Americans a huge amount (other
           | than they can get away with it), is to fund the research +
           | trials for the next generation of drugs.
           | 
           | Of course, even this argument doesn't hold water. I remember
           | when pharmaceuticals spent more on advertising/marketing than
           | on R&D (may still be the case).
        
           | gensym wrote:
           | 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.
        
       | dh2022 wrote:
       | 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.
        
       | Schnitz wrote:
       | 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.
        
       | philip1209 wrote:
       | What's to stop congress from passing a blanket "most favored
       | nation" law for VA + medicare on all pricing, inclusive of
       | insurance rates and discounts? Seems like it would be fair and
       | useful.
        
         | autoexec wrote:
         | The same thing that stops them from just joining the rest of
         | the first world nations and giving us universal healthcare.
         | Greed.
        
         | dlisboa wrote:
         | The US Congress doesn't pass laws anymore. Let alone fair and
         | useful ones.
        
         | llm_nerd wrote:
         | >"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.
        
         | actionfromafar wrote:
         | Trump already lowered costs of medicine by 1200%, what more do
         | you want?
         | 
         | We're gonna be so rich!
        
       | Animats wrote:
       | What's the price on TrumpRx.gov?
        
       | terminalshort wrote:
       | If a drug isn't one of the following it should be available over
       | the counter.
       | 
       | 1. heinously addictive
       | 
       | 2. incredibly dangerous when not used exactly correctly
       | 
       | 3. an antibiotic (due to the resistance externality)
       | 
       | And for drugs that do meet one of these conditions, doctors
       | should be able to write lifetime prescriptions for cases where
       | the medication is used to treat a permanent condition. This
       | probably covers 95% of non-antibiotic prescriptions. The savings
       | from removing the gatekeepers in terms of time and money would be
       | massive and the costs would be minimal.
        
         | dotancohen wrote:
         | Then who would feed the gatekeepers?
        
           | actionfromafar wrote:
           | How does it go?
           | 
           | "First, they came for the gatekeepers. Then, they came for
           | the billionaires."
        
         | renewiltord wrote:
         | 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.
        
       | Bender wrote:
       | 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]
        
         | philipkglass wrote:
         | According to another comment this product is pure
         | 1-(perfluorohexyl)octane [1]. There's no practical way to make
         | this chemical at home, but if you buy it in bulk from an
         | industrial supplier it can be had for $980-$750/kg, depending
         | on how many kilograms you commit to buy at once:
         | 
         | https://www.chemicalbook.com/ProductDetail_EN_1-perfluorohex...
         | 
         | Add analytical lab services to analyze it for purity and you
         | could still get a lifetime supply for the price of a couple of
         | brand-name bottles. This is the sort of thing that some
         | Americans have been doing to get cheap GLP-1 peptide drugs from
         | overseas too.
         | 
         | [1] https://en.wikipedia.org/wiki/Perfluorohexyloctane
        
         | actionfromafar wrote:
         | About 30 years in federal prison, probably.
        
       | labrador wrote:
       | We should in America should change our name to "The United States
       | of Greed" and be done with it. There would be less confusion that
       | way.
        
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