A $20 drug in Europe requires a prescription and $800 in the U.S.

Summary

A month’s supply of Miebo, Bausch & Lomb’s prescription dry eye drug, costs $800 or more in the U.S. before insurance. But the same drug — sold as EvoTears — has been available over-the-counter (OTC) in Europe since 2015 for about $20. I ordered it online from an overseas pharmacy for $32 including shipping, and it was delivered in a week. This is, of course, both shocking and unsurprising. A 2021 RAND study found U.S. prescription drug prices are, on average, more than 2.5 times higher than in 32 other developed nations. Miebo exemplifies how some pharmaceutical companies exploit regulatory loopholes and patent protections, prioritizing profits over patients, eroding trust in health care. But there is a way to fix this loophole. In December 2019, Bausch & Lomb, formerly a division of Valeant, acquired the exclusive license for the commercialization and development in the United States and Canada for NOV03, now called Miebo in the U.S. Rather than getting an approval for an OTC drug, like it is in Europe, Bausch secured U.S. Food and Drug Administration approval as a prescription medication, subsequently pricing it at a high level. Currently, according to GoodRx, a monthly supply of Miebo will cost $830.27 at Walgreens, and it’s listed at $818.38 on Amazon Pharmacy. The strategy has paid off: Miebo’s 2024 sales — its first full year — hit $172 million, surpassing the company’s projections of $95 million. The company now forecasts sales to exceed $500 million annually. At European prices, those sales would be less than $20 million. Emboldened with Miebo’s early success, Bausch & Lomb raised the price another 4% in 2025, according to the drug price tracking firm 46brooklyn. Bausch & Lomb has a track record of prioritizing profits over patients. As Valeant, its business model was simple: buy, gut, gouge, repeat. In 2015, it raised prices for Nitropress and Isuprel by over 200% and 500%, respectively, triggering a 2016 congressional hearing. Despite promises of reform, ...