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.

You could actually order this from amazon.de up until recently and have it shipped to you. That seems to have disappeared, though.

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.

>the actual cash-pay price is $225

So still 11x the price, plus whatever the prescription costs.

Unforgiveable.

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.

> 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.

> 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.

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).

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.

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.

(Not american) This assumes they have a choice, no? Do these medications have real alternatives?

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

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.

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.