When it comes to American medicine, we are definitely in a Dickensian best of times, worst of times situation. On the one hand, Big Pharma has created wonder drugs that can perform miracles, like the weight loss drugs that have helped even Amy Schumer! On the other hand, so many of these miracles are out of reach for those of us who aren’t movie stars.
Take, for example, the bizarre, outrageous differences in drug prices between the U.S. and other countries have eroded what little trust the American public had for its healthcare system. It’s created a situation where Big Pharma has sacrificed any goodwill it may have had while making itself an easy target for political leaders.
One particularly egregious example that’s emerged is Miebo, an artificial tears treatment for dry eyes created by Bausch & Lomb. To get a month’s supply of the drug in Europe — sold as EvoTears — costs $20 over-the-counter (OTC), but an $800 prescription here in the U.S. If you’re having a little trouble reading this because of dry eyes, you can find it on the cheap here.
Now if you’re worried that circumventing the US medical system may mean sad days for execs at Bausch & Lomb, don’t worry – they’re doing just fine.
In 2024 sales for Miebo were $172 million, almost double the company’s projections of just $95 million. Forecasts for 2026 are expected to exceed $500 million annually. If they gave us the same discount they give European clients, those sales would be below $20 million.
This is yet another example of how some pharmaceutical companies manipulate regulatory loopholes, patent protections, and Uncle Sam’s foolish generosity with federal health care dollars. Bausch & Lomb appear to be experts at exploiting the system. When the company was still called Valeant in 2015, it raised prices for Nitropress by 200% and Isuprel by 500%. This caused so much rancor that there was a Senate hearing about it. Bausch & Lomb’s current CEO, Brent Saunders, has promised “responsible pricing” but has gotten so creative with working the system he made a shady deal with the Mohawk Indian tribe when he was al Allergan.
One of the reasons they can get away with this is because the standard for what qualifies for OTC is much higher in the US than in Europe. (Europe is also blessed with much fewer lawyers than we have here, so medical companies don’t need to worry about as many frivolous lawsuits.) This process is enabled by the FDA’s OTC monograph process, which was designed probably with good intentions to assess the safety of nonprescription drugs. This process has proven itself out of date and needs to be changed.
Improvements to monograph must incorporate a mechanism so that overseas OTC status automatically triggers a review of comparable U.S. prescription drugs. Along with criteria to assess safety and efficacy standards, this would allow more drugs to circumvent the costly status as prescription drugs. This kind of policy change would discourage companies from changing the OTC label on drugs to ultra-expensive prescriptions ones. Prices would plummet.
EvoTears is sold abroad without the same safety concerns we have here … and it hasn’t blinded millions of Europeans. Industry claims that the U.S. needs stricter standards are bogus. The consumer gets lower prices from competition, and – thanks to the Internet and globalization – there’s never been a more consumer-friendly environment than ever before.
For decades, bad actors in the pharmaceutical industry have funded their huge profit margins by overcharging Americans, giving steep discounts abroad because other countries won’t pay their fair share. President Trump has negotiated deals with pharmaceutical companies to lower prices for Americans. Those companies should be applauded for coming to the table, cutting prices, and restoring a little faith in our health care system.
But as long as the Bausch & Lombs of the world continue to game the system and rip off Americans, Trump should hold them to account. Making more drugs over-the-counter and fostering competition would be a good start.
Jared Whitley has worked in the US Senate and White House. He has an MBA from Hult business school in Dubai. Recently the Top of the Rockies competition named him the best columnist in the Intermountain West.
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