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"
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.
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
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.
>So a lot of people who take this drug in the US actually pay $0 because they sign up for this card.
You do typically pay for insurance or otherwise have a reduced salary because your employer provides insurance, so saying you pay $0 isn’t really fair.
> Nobody in the US actually pays $800 for the drug.
The lowest I can buy this drug for is $819.26.
Period.
> That's the "list price" for insurance companies to pay.
$819.26 - $893.72 is the actual price (range) I must pay if I want to purchase this med.
Period. The tales to the contrary fell apart the moment they were scrutinized.
> Then the drug companies come in and offer a "savings card" which you apply at the pharmacy like another layer of insurance.
No. They don't. They pretend to. It is a lie, as delivered.
The manufacturer (Miebo) has a discount program. Miebo promises my cost for the eye drops will be ...
..."as low as $0"
But below that we are told this deal only for Eligible Commercially Insured Patients.
The ones with insurance that pays for the med.
This American, on the other hand, will pay $819.26 - $893.72.
Despite endless hints that there are pharma industry cards all over the place for the millions of millions of us who pay 100% out-of-pocket, there aren't.
What there are: Tightly bounded programs, primarily for newly released and evergreened drugs. Generally the discounted cost is still more than the nearly identical drug they're trying to replace.
> The FDA is partially to blame for this situation:
Not in a meaningful way. Even Dodge vs Ford is a greater factor. Even the stinking DEA does more harm to out of pocket drug consumers (because it does that harm ceaselessly).
> The cost of [ ... parrots pharma's trivially debunked talking points about why US Drug Consumers Must Get Gouged... ] back from insurers.
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.
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.
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.
It’s very simple. In the US your pharmacy has a contract with the drug supplier that prevents the pharmacist from telling you that you could buy the drug without insurance for $10 while he charges you the $20 copay. As long as this is legal and your pharmacist’s duty isn’t to you the patient, don’t waste time worrying about the details.
What's to stop congress from passing a blanket "most favored nation" law for VA + medicare on all pricing, inclusive of insurance rates and discounts? Seems like it would be fair and useful.
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.
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.
"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!
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.
Selling painkillers in 16 pill packets is a problem? It's readily available and very cheap (paracetamol and ibuprofen) generic brands. Never in my life this has been an issue
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.
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
36 comments
[ 2.7 ms ] story [ 53.5 ms ] threadBut it is absolutely revolutionary if you have dry eyes. Quotes include "I feel like my eye is actually too wet now"
https://en.wikipedia.org/wiki/The_St._Regis_Mohawk_Tribe_and...
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
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.
You do typically pay for insurance or otherwise have a reduced salary because your employer provides insurance, so saying you pay $0 isn’t really fair.
The lowest I can buy this drug for is $819.26.
Period.
> That's the "list price" for insurance companies to pay.
$819.26 - $893.72 is the actual price (range) I must pay if I want to purchase this med.
Period. The tales to the contrary fell apart the moment they were scrutinized.
> Then the drug companies come in and offer a "savings card" which you apply at the pharmacy like another layer of insurance.
No. They don't. They pretend to. It is a lie, as delivered.
The manufacturer (Miebo) has a discount program. Miebo promises my cost for the eye drops will be ...
..."as low as $0"
But below that we are told this deal only for Eligible Commercially Insured Patients.
The ones with insurance that pays for the med.
This American, on the other hand, will pay $819.26 - $893.72.
Despite endless hints that there are pharma industry cards all over the place for the millions of millions of us who pay 100% out-of-pocket, there aren't.
What there are: Tightly bounded programs, primarily for newly released and evergreened drugs. Generally the discounted cost is still more than the nearly identical drug they're trying to replace.
> The FDA is partially to blame for this situation:
Not in a meaningful way. Even Dodge vs Ford is a greater factor. Even the stinking DEA does more harm to out of pocket drug consumers (because it does that harm ceaselessly).
> The cost of [ ... parrots pharma's trivially debunked talking points about why US Drug Consumers Must Get Gouged... ] back from insurers.
No. ref: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
Analysis of ref: https://www.csrxp.org/dose-of-reality-new-study-debunks-big-...
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.
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.
</sarcasm>
() Biden's inflation act gave Medicare permission to start negotiating drug prices in 2026. Who know what the current US Administration will do though.
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.
[1] - https://fourthievesvinegar.org/
[2] - https://www.youtube.com/watch?v=5rQklSmI_F0 [video][1hr16m][DEFCON 32]
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