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

Original Article ↗ Hacker News Discussion ↗

PFAS safety and environmental concerns

  • The active ingredient (perfluorohexyloctane, a PFAS) alarms some commenters because it’s a “forever chemical” applied directly to the eye and ultimately entering the water cycle.
  • Others argue the scare is overblown: total volumes are tiny, PFAS are highly diluted in water supplies, and this specific compound has been used intraocularly for decades without known toxicity.
  • Debate centers on:
    • whether all PFAS should be treated as equally dangerous vs only certain long‑chain, bioaccumulative species;
    • whether lack of obvious short‑term harm is meaningful;
    • the ethics of creating more non‑degrading chemicals at all.
  • Several insist long‑term ecosystem and bioaccumulation risks remain unclear and that existing PFAS contamination already affects nearly everyone.

Effectiveness and alternatives for dry eye

  • Users describe the drug as “revolutionary” for severe dry eye, with much better relief than standard artificial tears.
  • Alternatives discussed: Restasis (cyclosporine A), punctal plugs or cauterization, vitamins and omega‑3 supplements, and other eye drops (including a Russian antioxidant product viewed skeptically as “snake oil” by some).
  • Consensus in the thread: standard supplements and conventional drops may help mildly but often don’t match perfluorohexyloctane’s effect.

Pricing gap and US system mechanics

  • Commenters note the US list price (~$800) vs ~€20 OTC in parts of Europe, calling this emblematic of US healthcare dysfunction.
  • Several explain that US list prices are largely fictional: insurers negotiate large discounts; manufacturers then use “savings cards” and copay assistance so many insured patients pay little or nothing out of pocket, while recouping costs via insurers and higher premiums.
  • Others push back that uninsured or poorly insured patients do pay list or near‑list prices, and assistance programs often exclude them.
  • There is dispute over how much FDA requirements and NDA costs (hundreds of millions vs billions) truly drive prices versus profit-seeking, PBMs, vertical integration, and lack of a single large public buyer.
  • Many contrast the US with European or other national systems that negotiate centrally, cap prices, and reduce patient bureaucracy.

Regulation, “free market,” and gatekeeping

  • Wide criticism that US healthcare is neither a true market nor a rational public system, but a “GDP shuffling” racket involving pharma, PBMs, insurers, and hospitals.
  • Others argue over how much regulation vs consolidation is to blame.
  • Broader discussion touches on:
    • restrictions on OTC vs prescription drugs differing by country;
    • gray/black markets, DIY sourcing of chemicals, and peptide vendors as cheaper alternatives;
    • strong support from many for some form of universal healthcare or at least stronger public option and price negotiation.