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.
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.
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?
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.
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.
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.
* https://news.ycombinator.com/item?id=44604365
* https://news.ycombinator.com/item?id=44989706California has an excellent non-profit option, and it depresses prices a bit, but not a huge amount
What about Warfarin? Its $21 for 30 pills, according to https://www.goodrx.com/warfarin
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-...
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 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 you would be _billed_ $10k but in reality you likely end up paying less than that. It's still scandalous, mind you.
That's pretty much the entire business model of GoodRx.
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.
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.
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.
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.
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.
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.
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 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.
Or you're on Medicaid if you live in a sane state.
https://www.cbpp.org/research/health/the-medicaid-coverage-g...
For example, my insurer does not cover weight loss medication. So starting next year, I'm on the hook for the $650 / month.
I could of course stay fat, get diabetes and then get on Mounjaro, which is covered.
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.
>the actual cash-pay price is $225
So still 11x the price, plus whatever the prescription costs.
Unforgiveable.
But it is absolutely revolutionary if you have dry eyes. Quotes include "I feel like my eye is actually too wet now"
And people put asbestos on their christmas trees back in the day - I don't think "obvious harm" is a high enough standard.
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.
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.
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.
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 do.
1. "PFAS" is a technically incorrect term. 2. It's ridiculously broad. Teflon is PFAS, sevoflurane is PFAS, and so on.
> If you actually think the scare is overblown, I dare you to drink the whole bottle of that eyedrop.
They literally use the same liquid to FILL THE EYEBALLS after retinal surgery. It's been approved for 25 years. A bottle of eyedrops has 4 milliliters of it, and it would do essentially nothing if swallowed.
This is why the PFAS scare is quite a bit silly. "PFAS" is such a broad category that it's ridiculous.
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.
> The lipid emission will heal partially if one supplements vitamin A (10k IU) softgel, omega-3 triglyceride ester, taurine, and at least 4K IU of vitamin D3. It will heal enough to work.
Omega-3 acids help a tiny bit, and I'm getting D3 and A from multivitamins. And I'm doing all other recommended stuff: eyelid washing, compresses, IPL, etc. Over the years, I tried discontinuing all of that a few times, and my symptoms worsened as a result. But not by much.
PFHO is the most effective "artificial tears" type product. Nothing comes close to it.
Here we go again with the PFAS. It is the stuff to prefer the least, not the most.
> I'm getting D3 and A from multivitamins
That fails completely because they almost always don't have softgel oil-dissolve forms or the right dose at all. They're generally very far from it. It is exactly what leads to the autoimmune issue of dry eyes in the first place.
> That fails completely because they almost always don't have softgel oil-dissolve forms or the right dose at all
I tried tons of forms. My current ones are gel-filled capsules. Rather large ones, at that.
Sorry, but there's a huge amount of scholarly literature on this question. I've read tons of it over the years, and there is NO magical supplement that does anything but mildly improve the situation.
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.
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.
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.
"First, they came for the gatekeepers. Then, they came for the billionaires."
Also, aren't most mostly benign drugs dangerous when combined with the wrong other mostly benign drugs? The gatekeeping protects against that.
I should be allowed to buy front line antibiotics from the grocery store. It’s infuriating that this is not possible..
See S. 2554, the "Patient Right to Know Drug Prices Act"
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.
[1] - https://fourthievesvinegar.org/
[2] - https://www.youtube.com/watch?v=5rQklSmI_F0 [video][1hr16m][DEFCON 32]
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.
https://www.boots.com/boots-ibuprofen-caplets-400mg-96s-1026...
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.
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
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?
One big benefit, though, is you can legally import or bring in POMs from overseas, a luxury the US does not have.
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.
And if you're a fan of Benadryl (diphenhydramine), don't expect to buy it in Latin America. It virtually doesn't exist.
Maybe in UK but I had not problem with that on the actual continent.
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
Maybe the next dem president will write an executive order directing the HHS to drop the enrollment age for Medicare to zero.
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.
We're gonna be so rich!
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.
() Biden's inflation act gave Medicare permission to start negotiating drug prices in 2026. Who know what the current US Administration will do though.
The whole PFAS scare is waaaaay too overblown.
</sarcasm>
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.
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.
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).
this argument is easily dismissible for any product that has high fixed costs but low marginal costs
which applies to a lot of drugs
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.
It’s totally fucked.
You could actually order this from amazon.de up until recently and have it shipped to you. That seems to have disappeared, though.
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.
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.
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.
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?
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
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.
https://en.wikipedia.org/wiki/The_St._Regis_Mohawk_Tribe_and...
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.
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?
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
> 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.
GP is right that monopolization and vertical integration (as you allude to in your comment) is much more salient.
The main expense is proving your drug works. It’s not really fair to describe that as incurred by FDA regs.
And in any case: drugs are (surprisingly) not a major driver of healthcare costs in the US.
The things that are uniquely costly in American healthcare are administrative overhead and doctors + nurses.
Go read KFF reporting on it.
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.
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).
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.
(Not american) This assumes they have a choice, no? Do these medications have real alternatives?
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.
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 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.