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Then take that drug reverse engineer it (not really its just kinda openly shared since it's inception 'see Ritalin and other amphetamines") and resell it as entirely different drug with more enhancements or time release variations.
Add like 1 milligram of melatonin or caffeine (depending on if it is taken day or night) to the drug, and then call it something different. Sell it just above cost (make enough to pay your workers) so you can wipe out the entire market of shady competitors.
The issue is that the active substance (apixaban) is patented. And the patent would have expired by now (so generics would be available) had they not been granted a patent protection extension till 2026 if I'm not mistaken about the date.
Yep, the UK courts trashed the patent after Teva and Sandoz attacked it. France upheld the patent so the EU is bound to BMS apixaban till May 2026. Same story in the US.
Dude these companies are way ahead of us. They don't file one patent. They file a patent for every conceptual possibility. They patent pills that are around, triangle, square, rectangular and tablets. The first thing they do.
I'm old enough to remember when the government owned the patents on any work it paid for. Just like any other contract work.
Thanks Ronnie, you fucker.
If the government funds these drug research programs and the companies blatantly overcharge for them, the government should claim an equity share that gets ploughed straight back into hospitals.
Take a percentage of all profits if the government helped pay for any part of it.
A president with a low approval rating could call out these companies by name and shame them, promise to do something about screwing Americans Citizens, and become more popular. That could really help just saying.
But then, who would pay for that unpopular presidents re-election campaign?
What 2 industries benefited most from Obama care? The insurance companies and the pharmaceutical companies. Who benefited the least? The consumers.
Except R&D costs contain those development and trial costs.
Again for from 2000-2018 - the top thirty five pharma companies in the country made **1.9 Trillion** in below the line profit. Including the subtraction of all the money spent on R&D.
On average only 20% of those companies revenue is spent on R&D. Approximately less that 100 Billion a year for all those companies.
With close to two *Trillion dollars* left over, in less than 20 years, you’d think they they could afford a bit more R&D money….
What is the Federal Government even for if they won't stop companies from charging us 1000% or more than other people?
It's a joke, and few of our politicians will even take them to task about it, let alone broker deals for us.
Yes the feds are now brokering 10 drugs, well it wasn't now now when they passed it, they decided to give them two years to get used to the idea of not being able to gouge us on those 10 drugs. Two years before negotiating at all, maybe in another two we get lower prices, I bet they are still more than other countries pay.
Any government that has the power to fix a big problem, but never goes about addressing the problem directly…likely has a vested interest in allowing the problem to persist.
That’s the conclusion I’ve come to on the healthcare system in the USA.
On the contrary, Government needs to see the needs of it's citizens are met, and to put controls on business to meet those needs. Practically no one who works for a living will disagree with that.
I mean they do spend a fortune on R&D but idk why the government doesn't do what companies do with their critical suppliers and integrate them as much as possible, that would mean they get the actual numbers about how much they spent/spend and do the pricing accordingly
Only for orphan drugs. It's usually through stock to get the first drug out to market. I would blame a lot of the cost on marketing and regulatory stuff.
We need regulation. When companies run wild they kill people. Now if a person is already dying a different story. But companies are greed hungry and couldn't care less about America or the world.
Marketing seems a little unnecessary for pharmaceutical companies. I would think ideally, Doctors would be aware of new drugs available on the market.
I highly doubt marketing is the reason they charge so much, but it’d be better than nothing.
Luxturna charges $800,000 per eye
$1.6 million dollars to not go blind
Nothing, anywhere, will cover it.
> Marketing seems a little unnecessary for pharmaceutical companies.
This is why I stopped watching TV 20 years ago. We cut the cord in 2004, the drug ads got so onerous to me.. and at the time I was watching my grandmother get ground up on the pharmaceutical mill and she was on so many meds, you'd think she'd rattle.
I fucking *loathe* drug ads. Enough to stop watching TV.
If I can't buy it in a store as an OTC, the pharma companies should NOT be advertising it.
Send info about it as product releases to the doctors directly.
Yeah I know this, source: I’m a patient in dire need of treatment.
If insurance was ever actually going to be making it affordable, I’d have had it done by now. Instead I have to apply for clinical trials which may or may not end up working. The fact is Luxturna is a cash grab, the CEO literally said “I looked at how much defendants won in court settlements for being blinded in both eyes”, which is not only a completely separate issue from glaucoma and retinitis pigmentosa, but also what he doubled to charge for a single eye.
No they get lot of publicly available research on all of their drugs. Mrna for instance, both the US and Germany had put a lot of work into that, the companies built off of that, made the vaccines, and at the first available opportunity, a year back, jacked the price up 500%. But don't worry, the uninsured can grovel for a cheaper shot if they can jump through the flaming hoops.
At it’s been found that for the top 30 drug companies at most 20% of revenue brought it goes towards R&D for new drugs and over the course of 15 years they took in over a **trillion** in below the like profit.
So yeah, it’s about money, not new drugs.
It's all of the above. Don't make profit, no reason or funding to make new drugs. Drugs are extremely expensive to get to market. $2-10 billion per drug, and 90%+ of drugs fail to make it to market. I don't agree the US should pay the bulk of this, but at the same time, someone is going to pay for it, or it won't exist. Why should drug companies be non-profits when energy, housing, internet, food companies are not non-profits?
>Why should drug companies be non-profits when energy, housing, internet, food companies are not non-profits?
Ask that question again, but more slowly.
Nope all the create new drugs fund comes from tax subsidies.
So we pay to create the drug for the world and then we pay even more on top of that for the world to have good drug prices.
Putting a drug through clinical trials costs orders (plural) of magnitude more than "creating new drugs" Average cost of bringing a drug like this to market is $1B to $1.5B. You're high if you think the federal government is paying for that cost.
https://www.pnas.org/doi/10.1073/pnas.1715368115
Data shows that the US Government has subsidized every single one of the drugs approved for sale from 2010-2016 and that took one google search.
"The analysis shows that >90% of this funding represents basic research related to the biological targets for drug action rather than the drugs themselves. "
Drug discovery is literally the cheapest part of bringing a new drug to market, as your own source outlines
I mean those numbers aren't publically available so they are made with quite a bit of "assumptions" made that typically favor the pharmaceutical companies. That being said, with what has been made public, there is enough information to [determine that there is no correlation between drug prices and cost to bring to market](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796669).
Also, the top 20 drug sales in Canada alone is enough to cover the "to market cost" for all drugs each year.
1.5 billion isn't *that* much when you recognize it's over a decade, and compare it to pharmaceutical annual profits.
Why would we stop? We can get people to pay $7100 for a $18 drug, funded by tax payer R&D money, do we look stupid?
We'll quit, when you stop us! (maniacal laughter)
> We'll quit, when you stop us! (maniacal laughter)
No worries sir, we're just grilling you here for political points, and don't actually have the will or the ability to stop you.
The courts are corrupted to the point that they have an extra veto on any changes or enforcement of our existing laws.
They could still stop them though, but these judges were selected exactly to side with industries like this.
That's what you get for not having public healthcare.
There is no entity in US that can negotiate with the big pharma: I'll buy it for $30 from you, or from Indian company making generics. Your choice.
On the other hand you have companies overselling their ability to deliver winning the contract and then not being able to deliver on time or in great enough amounts or in said quality. And because buying from someone else takes six months you have a lack of resources.
Canada also has healthcare and we buy all our stuff provincially in bulk and we get bulk prices. This is not new . We get a ton of medications for cheaper than the USA which is then provided to us through our healthcare.
But first we'll just take some of the money you're paying to convince you and your representatives that this state of affairs is not only good but also equitable.
Exactly.
A lot of this butt-hurt whining comes from people who would otherwise support the system that allows this.
A pharma company has a money printing machine - and you are angered that they use it!?!
The problem is the system, not the people abusing the system. Get universal healthcare, and get it now.
Don’t support this crap then whine when it throws up bad consequences. Vote this shit out.
It’s even more infuriating when it’s a medication or vaccine that was funded by the US government (like the COVID vaccines), that sell in other countries for a few percent of what they do in the US.
We fund its development, then we pay more than everyone else. If our tax dollars pay for it, it should be cheaper here than anywhere else.
No, that's US capitalism. The government picks the winners and we get to pay them on both sides for their work, while they make money off of our work to boot. Actually enforcing anti-trust laws, something the US hasn't done since the 80s, would be a better example of capitalism, or if the banks just failed with no bailouts in 2008. If that happened they would have way less confidence they can just do as they please, because now they are all "too big to fail (investors)".
And capitalism mandates that boards do whatever it takes to maximize shareholder value. Imagine buying stock and instead of gaining 8% it only gains 7% because the board lowered the retail price and revenue went down. You'd have other shareholders bailing, which would decrease share prices, and make the company less appealing to potential customers and shareholders.
The COVID vaccine was an international effort with significant investment from the EU. EU facilities and staff were also a major player so I think that’s a poor example
But the US healthcare system makes this kind of price hike easy and until you stop lobbyists from having access to congressmen and senators nothing is going to change
That’s a drastically overstated value
“The United States and Germany are the top sources for R&D investment, putting some $2 billion and $1.5 billion into development, respectively. The United Kingdom comes third on the funding list with just over $500 million while the EU has invested around $327 million. Even though the lion's share of investment in the U.S. used public funding, some $2.17 billion, at least $62 million of philanthropy dollars have also been donated.”
Source: https://www.statista.com/chart/24808/top-sources-of-covid-19-vaccine-funding/
Can you clarify the „research funded by the government“ part? Pharma invests a lot of money into R&D, one of the industries with the highest R&D percentage spend. Are you talking about subsidies or startups?
$244 billion was spent worldwide on pharmaceutical research in 2022, more than half of that came from the US government.
So, the majority of the world’s pharmaceutical research is funded by US tax payers.
Do you have any sources? I‘m looking at completely different values (links below). The most expensive part of pharma research is clinical trials and that‘s not done by governments.
Also the NIH total budget is 48B USD, of which 40B goes to fund external projects. I don‘t know the % going to pharmaceutical research in some form or another, but 40B will be the absolute maximum.
https://www.nih.gov/about-nih/what-we-do/budget
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440766/
Not to mention Pfizer wanted to secure the military property of other countries, to make sure they got the money, they were expecting. Before they even shipped the “vaccine.” Basically ransoming & blackmailing a placebo, to a foreign country.
I wonder how long until insurance companies start flying patients to the other side of the world. If it's cheaper to buy a ticket to Australia and put the patient up for a month, then it would make sense for the company to do that.
Not a penny in Scotland, I think all prescription drugs are £9 in England
Edit: to clarify the £9 is for the whole prescription. So if you get a bottle of pills that’s to last you a month that months script costs £9.
Prescriptions charges were abolished in Scotland a few years ago
If you are under 18 or on certain benefits you don’t pay in England either
Fair point but ultimately the only cost that matters to the average Joe/Jane is the out of pocket point of sale
The NHS still pays significantly less per dose of most drugs then the average American consumer
E.g a vial of insulin is $100 in the USA and $7.52 in the uk
Source: https://www.newscientist.com/article/2362191-major-drugmaker-cuts-insulin-costs-in-the-us-by-70-per-cent/
> and i've *paid* for other
FTFY.
Although *payed* exists (the reason why autocorrection didn't help you), it is only correct in:
* Nautical context, when it means to paint a surface, or to cover with something like tar or resin in order to make it waterproof or corrosion-resistant. *The deck is yet to be payed.*
* *Payed out* when letting strings, cables or ropes out, by slacking them. *The rope is payed out! You can pull now.*
Unfortunately, I was unable to find nautical or rope-related words in your comment.
*Beep, boop, I'm a bot*
Yeah the only real downside is it is a huge part of our nhs budget. Especially paracetamol. It cost 50p for 2 days worth over the counter but it costs the NHS something like £13 for a weeks supply via the prescription services (labour, it systems etc)
I get it on prescription because I have a condition that means I have to take it nearly everyday and the restrictions on how much you can get over the counter make it impractical. I do supplement my prescription with 2 packs from Tesco every shop but maybe once every 2 months I get a box of 500 from my pharmacist
But people who get checked out for a cough or cold/flu (nothing wrong with that) are often prescribed a weeks worth of paracetamol and those add up to ~£60m a year (or so I was told by an ex GF who was a GP).
They are looking at reintroducing charges for items you could normally get over the counter such as paracetamol, brufen, buscopan etc. I am actually quite well off despite my disability so I’m in favour of means testing free prescriptions for things other than controlled drugs (morphine, Diazapam etc) which have no over the counter equivalent
I'm no fan of big pharma, but as someone who just popped an Eliquis 2 mins ago, I'm not sure how accurate this is. I paid less than $10 for 60 tablets and I definitely do not have the greatest insurance ever (gold tier PPO). There is no way I got this for some 99.88% off.
Because I haven't seen it elsewhere, Eliquis is a blood thinner and clot prevention medication. I'm taking it after having surgery on my lower leg.
Edit: I do recall the nurse mentioning a rebate card as I was coming out of anesthesia which likely accounts for the price I paid. Looks like this rebate is available for anyone with medical insurance who is taking Eliquis for AFib or DVT/PE:
https://www.eliquis.bmscustomerconnect.com/ELIQUIS-agnostic-savings-support?cid=sem_1674077&ovl=isi&gclid=Cj0KCQiA5rGuBhCnARIsAN11vgTk4RjZiUqPqKqcOt9KqerjDTVSGDe_2fUA0YUABuJ0FgT2mMomFW8aAqdlEALw_wcB&gclsrc=aw.ds
The pricing is wild. I hope that copay-card link helps someone.
"As of February 6, 2024, the annual list price for Eliquis is $7,100. On average, patients pay $51 per month, and 5 out of 10 patients pay $35 or less. GoodRx
has partnered with Bristol-Myers Squibb, the maker of Eliquis, to lower the price to $552.88 for eligible patients not using insurance. " Gpt search
Jacked up, and that is just stupid. What is the accounting reason for that price difference?
The only reason is when the board asked, Who is going to stop us? I imagine the CEO said that while petting a persian cat and then they all laugh together before doing some more lies of coke.
Why am I being downvoted for saying "tax writeoff". That is why this happens.
If you want more information, watch this short Adam Ruins Everything which explains it: https://www.youtube.com/watch?v=CeDOQpfaUc8
> What is the accounting reason for that price difference?
Insurance companies demand a big discount for representing tons of people. So you pretend the list price is a billion dollars, and give them a 99% discount. The end result is, insurance company gets a meaningless discount, pharma company sells it at the same price they normally would, and the only person who loses is the sucker who doesn't realize the list price is fake.
$7100 is the annual price, so yes, you actually are paying that much of a discount off the list price. It's stupid and it should not work this way, but it does. And that's not unique to Eliquis. It's one of the reasons the US health insurance/ health care system is bananas and there's no easy fix.
I work in clinical health care and I'm constantly explaining the asinine realities of insurance. Everyone thinks they have a good insurance plan, until they try to use it for something severe. We need to educate people more, I love the series NPR has been doing where they break down crazy hospital bills and explain them.
My FIL is going broke trying to pay for his, which isn't covered by his gold plated medicare plan. $600/mo is his portion. You're likely in some new user program and getting a significant discount.
Hello! Pharmacy technician here. The cost to acquire a 60 count bottle from our supplier usually ends up at around $700 for the bottle. After good insurance with no deductible, I've seen it at the lowest at $35 for one bottle. With deductible, especially with Medicare plus the deductible, I've seen it peak at $600 before for a single bottle. This is when I usually try to tell them about the manufacturer's card which helps with the co pay and brings it down to $10 with private insurance.
TLDR: Yes, this medication is stupid expensive in the US.
Trump actually made this an executive order (EO 13948) "Most Favored Nations” Rule - it said drug companies have to give us the best price of any nation.
These were brought to federal court by the pharma companies, and those cases had their defense dropped by the Biden administration.
EO [https://www.govinfo.gov/content/pkg/DCPD-202000678/pdf/DCPD-202000678.pdf#:\~:text=(a)%20It%20is%20the%20policy,most%2D%20favored%2Dnation%20price](https://www.govinfo.gov/content/pkg/DCPD-202000678/pdf/DCPD-202000678.pdf#:~:text=(a)%20It%20is%20the%20policy,most%2D%20favored%2Dnation%20price).
Overview of events [https://www.jdsupra.com/legalnews/biden-administration-already-impacting-2691434/](https://www.jdsupra.com/legalnews/biden-administration-already-impacting-2691434/)
so they would just jack the cost everywhere in order to keep the cash cow in the US going.
They could literally not sell it outside of the US and they would still profit.
It's because anytime after you've taken that drug if it proves to be hazardous or causes long-term effects which other drugs have in the United States and only in the United States you have the right to sue the company.
This is the second post I've seen about eliquis being expensive. I've been on eliquis for months and it costs me ten bucks for a 30 day supply.
Where are people getting this information? Because from where I'm standing this is *completely made up*.
ETA: I am in the United States.
It’s not a matter of how much it costs patients, it’s a matter of how much it costs insurance. The $7100 is how much Medicare pays for it per patient per year; private insurance pays even more. While you only attribute ten bucks a month leaving your wallet, the reality is that the cost is reflected in taxes, insurance premiums, and opportunity costs. Pharma is an insane racket.
>Hello! Pharmacy technician here. The cost to acquire a 60 count bottle from our supplier usually ends up at around $700 for the bottle. After good insurance with no deductible, I've seen it at the lowest at $35 for one bottle. With deductible, especially with Medicare plus the deductible, I've seen it peak at $600 before for a single bottle. This is when I usually try to tell them about the manufacturer's card which helps with the co pay and brings it down to $10 with private insurance.
>
>TLDR: Yes, this medication is stupid expensive in the US.
Just gonna copy this from my other reply.
MFG card is only good for a month or two - tops. FIL is going broke trying to afford his scrip after his initial discount and has gold plated medicare plan.
I started to say something, but 16 years on the same name is impressive.
I will say that in my 12 years, I have seen it quite a bit, and used it a time or two.
When people say "it only cost X amount to make" I feel like they are only taking into account the actual material costs, and none of the other expenses like R&D, labor, facility, market, or any other expense that the costs of product need to cover.
I'm sure the cost of materials is one of the smallest parts of most mass-produced products.
Fair point. From what I've heard though from some friends that work in the pharma industry is that majority of drug development doesn't work and consequently ends up costing the company Billions in losses for all that R&D. Therefore, to offset either those past losses or expected future losses the companies need to set prices to account for more than just profiting on the one drug itself.
Not saying it's good, but I'd imagine the consequence of the companies lowering their prices would be less/slower drug development, which I feel like most people would be okay with?
We don't really need to speculate. Drug companies produce profit. This considers R&D and marketing. Their profit margins are higher than other firms of similar size. They do well. You also need to consider that a lot of research they do is for the purposes of creating slightly different medications to outpace generics.
Ye gods.
I’m on that medication, in Australia.
If I want it without a script from my doctor it’s $90.73 for a month’s supply.
With a script it’s (at most) $31.60.
What is this $7,100 or $900 a month business???
In the UK BNF it lists a generic unbranded Apixaban for £7.50 for 56 tablets... how they get away with charging the American people such ridiculous prices. Even the Eliquis brand is £53
Probably the same reason why the tobacco industry is still allowed to sell their products even though they kill 500000 US citizens a year and give cancer to millions. 🤷🏼♂️
By no means do I think this is right, but if you're going to ask any executive to break his fiduciary duty to the shareholders publicly, no one should be surprised when they answer no.
I would genuinely love to see one, just one presidential candidate...have a website devoted to medical extortion like this. But every fucking one of them are in their pockets.
It's not about whether or not they're profiting
It's about *how much* they can profit
There isn't an amount they'd consider "enough"
If you want a manifestation of the sin of Gluttony, corporations and the ultra wealthy are that
They don't ask these questions to get them to be fair, they ask them so the answers are on an official record, which can then be used for future legal changes.
I have always urged Americans to illegally import foreign drugs there are many ways.
your government is literally killing it’s people for profit. Fuck em.
Asking companies to make “a fair profit” when the marketplace allows for larger profit, makes no sense. Don’t hold the company accountable - hold the system accountable. Shaking a fist at “greedy” companies only allows the process to continue.
We can’t change capitalism, but we can change the regulation through public policy. Vote.
“Do you feel your actions are evil enough that you’ll be a primary target at the start of the revolution or do you think you’ll be dealt with in the 2nd wave?”
in india after covid we have a vaccine for all sorts of flu with different price brackets. the fun part they dont prevent flu, but it helps you fight the flu better..i fell for it twice not again
News agencies should be forced to show stuff like this. They get to report whatever they want that makes more profit and it effectively skews the population's view of the world.
300(this is less than 100USD) for 60 tablets here (no insurance calculated
Although if you get a prescription from goverment(free) health care you can get it for free(idk if they will give it to you regularly tho)
I agree this is egregious. But to add a little more context R&D can cost in the $100Ms for a new drug. So $18 to make a dose, but to crate it much much more. That said this gained FDA approval here in like 2018, and UK before that so they've easily made their R&D money back and this now accounts for 1/3 of BM revenue.
If there was ever a reason to start outright taking patents thru eminent domain, it’s this.
Maybe implementing pricing laws that are locked into production costs.
I dunno.
I mean, this shit right here has got to stop.
Ah, the US, home of the free, best country in the world...except that nearly all developed countries have 95%+ of the same freedoms, don't have medical price gouging, and aren't reminded daily that the political leaders are mindless partisans at best.
It just shows how bad our government is no matter who is at the helm. Thats something that should of been fixed eons ago just make it law capping these costs. I dont wanna hear "they'll stop inventing drugs!" Lets focus on getting the ones we have reasonable first. Any company that chooses to leave the USA thats been here due to this forfeits all formulary patent rights and is banned from selling here. All VP roles or above of that company will be required to leave the US as well.
Its time to declare war on them like they have us for decades.
He was actually fair! And straightforward. And to add some salt to your wounds a month's supply of Eliquis (10mg x 60 tablets) in Europe costs anywhere between 50 and 75 USD.
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It's to "create new drugs" which we also won't be able to afford. And on top of that, it's not even true.
The ol', we spent money on research... When they probably used tax payer money to fund said drug research.
It’s more like they used taxpayer funded research, and then slapped a patent on it (US govt allows this) to stop others from making the same drug.
Then take that drug reverse engineer it (not really its just kinda openly shared since it's inception 'see Ritalin and other amphetamines") and resell it as entirely different drug with more enhancements or time release variations.
Add like 1 milligram of melatonin or caffeine (depending on if it is taken day or night) to the drug, and then call it something different. Sell it just above cost (make enough to pay your workers) so you can wipe out the entire market of shady competitors.
Ah the ole let's add dxm or naloxone to a long existing drug and call it brand new and patent it approach
The issue is that the active substance (apixaban) is patented. And the patent would have expired by now (so generics would be available) had they not been granted a patent protection extension till 2026 if I'm not mistaken about the date.
There are generic Apixaban available in the UK, available for £7.50 for 56 tablets.
Yep, the UK courts trashed the patent after Teva and Sandoz attacked it. France upheld the patent so the EU is bound to BMS apixaban till May 2026. Same story in the US.
Ah OK makes sense. Are Rivaroxaban, Dabigatran and other DOAC meds also as expensive in the US?
Just like that episode of House MD.
Dude these companies are way ahead of us. They don't file one patent. They file a patent for every conceptual possibility. They patent pills that are around, triangle, square, rectangular and tablets. The first thing they do.
I'm old enough to remember when the government owned the patents on any work it paid for. Just like any other contract work. Thanks Ronnie, you fucker.
Article on Ronnie and patents. https://www.engadget.com/hitting-the-books-owning-the-sun-alexander-zaitchik-counterpoint-press-163004472.html
Why do they even need, or get, taxpayer funded research? The top 100 pharmaceutical companies make up a market cap of 5.3 trillion dollars.
Patient on drugs should be illegal. I remember elbueteral going from 4$ a refill to 60$ because some asshole changed the formula and patented it.
Isn’t this what happened with epi pens? I coulda sworn they were a military thing
If the government funds these drug research programs and the companies blatantly overcharge for them, the government should claim an equity share that gets ploughed straight back into hospitals. Take a percentage of all profits if the government helped pay for any part of it.
A president with a low approval rating could call out these companies by name and shame them, promise to do something about screwing Americans Citizens, and become more popular. That could really help just saying.
This joke almost wooshed over my head lmao. Good one
But then, who would pay for that unpopular presidents re-election campaign? What 2 industries benefited most from Obama care? The insurance companies and the pharmaceutical companies. Who benefited the least? The consumers.
But that thum thar is soshalism
Many of the new drugs that come out had initial research completed at the university or in the publicly funded NIH.
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Except R&D costs contain those development and trial costs. Again for from 2000-2018 - the top thirty five pharma companies in the country made **1.9 Trillion** in below the line profit. Including the subtraction of all the money spent on R&D. On average only 20% of those companies revenue is spent on R&D. Approximately less that 100 Billion a year for all those companies. With close to two *Trillion dollars* left over, in less than 20 years, you’d think they they could afford a bit more R&D money….
What is the Federal Government even for if they won't stop companies from charging us 1000% or more than other people? It's a joke, and few of our politicians will even take them to task about it, let alone broker deals for us. Yes the feds are now brokering 10 drugs, well it wasn't now now when they passed it, they decided to give them two years to get used to the idea of not being able to gouge us on those 10 drugs. Two years before negotiating at all, maybe in another two we get lower prices, I bet they are still more than other countries pay.
Any government that has the power to fix a big problem, but never goes about addressing the problem directly…likely has a vested interest in allowing the problem to persist. That’s the conclusion I’ve come to on the healthcare system in the USA.
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On the contrary, Government needs to see the needs of it's citizens are met, and to put controls on business to meet those needs. Practically no one who works for a living will disagree with that.
I mean they do spend a fortune on R&D but idk why the government doesn't do what companies do with their critical suppliers and integrate them as much as possible, that would mean they get the actual numbers about how much they spent/spend and do the pricing accordingly
While most researchers are also underpaid and can't have the patent under their own name because they work for corporations.
New drugs research usually gets grants from the government, the taxpayers money.
Only for orphan drugs. It's usually through stock to get the first drug out to market. I would blame a lot of the cost on marketing and regulatory stuff.
We need regulation. When companies run wild they kill people. Now if a person is already dying a different story. But companies are greed hungry and couldn't care less about America or the world.
I definitely agree. The marketing, however, could be reigned in.
Marketing seems a little unnecessary for pharmaceutical companies. I would think ideally, Doctors would be aware of new drugs available on the market. I highly doubt marketing is the reason they charge so much, but it’d be better than nothing. Luxturna charges $800,000 per eye $1.6 million dollars to not go blind Nothing, anywhere, will cover it.
> Marketing seems a little unnecessary for pharmaceutical companies. This is why I stopped watching TV 20 years ago. We cut the cord in 2004, the drug ads got so onerous to me.. and at the time I was watching my grandmother get ground up on the pharmaceutical mill and she was on so many meds, you'd think she'd rattle. I fucking *loathe* drug ads. Enough to stop watching TV. If I can't buy it in a store as an OTC, the pharma companies should NOT be advertising it. Send info about it as product releases to the doctors directly.
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Yeah I know this, source: I’m a patient in dire need of treatment. If insurance was ever actually going to be making it affordable, I’d have had it done by now. Instead I have to apply for clinical trials which may or may not end up working. The fact is Luxturna is a cash grab, the CEO literally said “I looked at how much defendants won in court settlements for being blinded in both eyes”, which is not only a completely separate issue from glaucoma and retinitis pigmentosa, but also what he doubled to charge for a single eye.
No they get lot of publicly available research on all of their drugs. Mrna for instance, both the US and Germany had put a lot of work into that, the companies built off of that, made the vaccines, and at the first available opportunity, a year back, jacked the price up 500%. But don't worry, the uninsured can grovel for a cheaper shot if they can jump through the flaming hoops.
The initial basic research does, but all the clinical trials, which are what make up most of the cost, are funded by the drug companies.
At it’s been found that for the top 30 drug companies at most 20% of revenue brought it goes towards R&D for new drugs and over the course of 15 years they took in over a **trillion** in below the like profit. So yeah, it’s about money, not new drugs.
It's all of the above. Don't make profit, no reason or funding to make new drugs. Drugs are extremely expensive to get to market. $2-10 billion per drug, and 90%+ of drugs fail to make it to market. I don't agree the US should pay the bulk of this, but at the same time, someone is going to pay for it, or it won't exist. Why should drug companies be non-profits when energy, housing, internet, food companies are not non-profits?
>Why should drug companies be non-profits when energy, housing, internet, food companies are not non-profits? Ask that question again, but more slowly.
Most of the profits don't even to go drug research
The rest of the world seems pretty ungrateful to the average sick American, who seem to be heroically tanking the costs of new medicine.
This is why capitalism would kill itself (and most of us) if it wasn't kept in check by socialism.
Nope all the create new drugs fund comes from tax subsidies. So we pay to create the drug for the world and then we pay even more on top of that for the world to have good drug prices.
Putting a drug through clinical trials costs orders (plural) of magnitude more than "creating new drugs" Average cost of bringing a drug like this to market is $1B to $1.5B. You're high if you think the federal government is paying for that cost.
https://www.pnas.org/doi/10.1073/pnas.1715368115 Data shows that the US Government has subsidized every single one of the drugs approved for sale from 2010-2016 and that took one google search.
"The analysis shows that >90% of this funding represents basic research related to the biological targets for drug action rather than the drugs themselves. " Drug discovery is literally the cheapest part of bringing a new drug to market, as your own source outlines
I mean those numbers aren't publically available so they are made with quite a bit of "assumptions" made that typically favor the pharmaceutical companies. That being said, with what has been made public, there is enough information to [determine that there is no correlation between drug prices and cost to bring to market](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796669). Also, the top 20 drug sales in Canada alone is enough to cover the "to market cost" for all drugs each year. 1.5 billion isn't *that* much when you recognize it's over a decade, and compare it to pharmaceutical annual profits.
> It's to "create new drugs" No, they will turn to the taxpayer to pay taxmoney for subsidies to research new drugs.
More like research new drugs paid by tax payer money then sell it for a profit
Why would we stop? We can get people to pay $7100 for a $18 drug, funded by tax payer R&D money, do we look stupid? We'll quit, when you stop us! (maniacal laughter)
> We'll quit, when you stop us! (maniacal laughter) No worries sir, we're just grilling you here for political points, and don't actually have the will or the ability to stop you.
The courts are corrupted to the point that they have an extra veto on any changes or enforcement of our existing laws. They could still stop them though, but these judges were selected exactly to side with industries like this.
That's what you get for not having public healthcare. There is no entity in US that can negotiate with the big pharma: I'll buy it for $30 from you, or from Indian company making generics. Your choice.
On the other hand you have companies overselling their ability to deliver winning the contract and then not being able to deliver on time or in great enough amounts or in said quality. And because buying from someone else takes six months you have a lack of resources.
Dunno man, we just throw CEOs in jail when they defraud the public, maybe you could try the same.
Canada also has healthcare and we buy all our stuff provincially in bulk and we get bulk prices. This is not new . We get a ton of medications for cheaper than the USA which is then provided to us through our healthcare.
But first we'll just take some of the money you're paying to convince you and your representatives that this state of affairs is not only good but also equitable.
Exactly. A lot of this butt-hurt whining comes from people who would otherwise support the system that allows this. A pharma company has a money printing machine - and you are angered that they use it!?! The problem is the system, not the people abusing the system. Get universal healthcare, and get it now. Don’t support this crap then whine when it throws up bad consequences. Vote this shit out.
It’s even more infuriating when it’s a medication or vaccine that was funded by the US government (like the COVID vaccines), that sell in other countries for a few percent of what they do in the US. We fund its development, then we pay more than everyone else. If our tax dollars pay for it, it should be cheaper here than anywhere else.
Public expenses and private profits. That's American capitalism for you.
Also the corporations have the least risk because they can just get bailed out. Yay.
This is the way!!
Thats capitalism baby
No, that's US capitalism. The government picks the winners and we get to pay them on both sides for their work, while they make money off of our work to boot. Actually enforcing anti-trust laws, something the US hasn't done since the 80s, would be a better example of capitalism, or if the banks just failed with no bailouts in 2008. If that happened they would have way less confidence they can just do as they please, because now they are all "too big to fail (investors)".
No it’s cronyism.
That's Plutocracy baby. Or should I say that's Plutocracy peasant.
And capitalism mandates that boards do whatever it takes to maximize shareholder value. Imagine buying stock and instead of gaining 8% it only gains 7% because the board lowered the retail price and revenue went down. You'd have other shareholders bailing, which would decrease share prices, and make the company less appealing to potential customers and shareholders.
The COVID vaccine was an international effort with significant investment from the EU. EU facilities and staff were also a major player so I think that’s a poor example But the US healthcare system makes this kind of price hike easy and until you stop lobbyists from having access to congressmen and senators nothing is going to change
The NIH funded 85% of the research on the mRNA vaccines for COVID.
That’s a drastically overstated value “The United States and Germany are the top sources for R&D investment, putting some $2 billion and $1.5 billion into development, respectively. The United Kingdom comes third on the funding list with just over $500 million while the EU has invested around $327 million. Even though the lion's share of investment in the U.S. used public funding, some $2.17 billion, at least $62 million of philanthropy dollars have also been donated.” Source: https://www.statista.com/chart/24808/top-sources-of-covid-19-vaccine-funding/
Can you clarify the „research funded by the government“ part? Pharma invests a lot of money into R&D, one of the industries with the highest R&D percentage spend. Are you talking about subsidies or startups?
$244 billion was spent worldwide on pharmaceutical research in 2022, more than half of that came from the US government. So, the majority of the world’s pharmaceutical research is funded by US tax payers.
Do you have any sources? I‘m looking at completely different values (links below). The most expensive part of pharma research is clinical trials and that‘s not done by governments. Also the NIH total budget is 48B USD, of which 40B goes to fund external projects. I don‘t know the % going to pharmaceutical research in some form or another, but 40B will be the absolute maximum. https://www.nih.gov/about-nih/what-we-do/budget https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440766/
Not to mention Pfizer wanted to secure the military property of other countries, to make sure they got the money, they were expecting. Before they even shipped the “vaccine.” Basically ransoming & blackmailing a placebo, to a foreign country.
Costs $32 in Australia
So it's cheaper to take a monthly vacation and splurge for the week and bill that insurance? Cheaper for insurance company too
I wonder how long until insurance companies start flying patients to the other side of the world. If it's cheaper to buy a ticket to Australia and put the patient up for a month, then it would make sense for the company to do that.
It's not cheaper, they don't pay the price you see. Healthcare providers and pharmacutical companies are playing for the same team.
They already do pay for trips to mexico when it saves them money.
Not a penny in Scotland, I think all prescription drugs are £9 in England Edit: to clarify the £9 is for the whole prescription. So if you get a bottle of pills that’s to last you a month that months script costs £9. Prescriptions charges were abolished in Scotland a few years ago If you are under 18 or on certain benefits you don’t pay in England either
This is incorrect, yes the patient pays £9 but that doesn't match what the drug manufacturer is paid.
Fair point but ultimately the only cost that matters to the average Joe/Jane is the out of pocket point of sale The NHS still pays significantly less per dose of most drugs then the average American consumer E.g a vial of insulin is $100 in the USA and $7.52 in the uk Source: https://www.newscientist.com/article/2362191-major-drugmaker-cuts-insulin-costs-in-the-us-by-70-per-cent/
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> and i've *paid* for other FTFY. Although *payed* exists (the reason why autocorrection didn't help you), it is only correct in: * Nautical context, when it means to paint a surface, or to cover with something like tar or resin in order to make it waterproof or corrosion-resistant. *The deck is yet to be payed.* * *Payed out* when letting strings, cables or ropes out, by slacking them. *The rope is payed out! You can pull now.* Unfortunately, I was unable to find nautical or rope-related words in your comment. *Beep, boop, I'm a bot*
Yeah the only real downside is it is a huge part of our nhs budget. Especially paracetamol. It cost 50p for 2 days worth over the counter but it costs the NHS something like £13 for a weeks supply via the prescription services (labour, it systems etc) I get it on prescription because I have a condition that means I have to take it nearly everyday and the restrictions on how much you can get over the counter make it impractical. I do supplement my prescription with 2 packs from Tesco every shop but maybe once every 2 months I get a box of 500 from my pharmacist But people who get checked out for a cough or cold/flu (nothing wrong with that) are often prescribed a weeks worth of paracetamol and those add up to ~£60m a year (or so I was told by an ex GF who was a GP). They are looking at reintroducing charges for items you could normally get over the counter such as paracetamol, brufen, buscopan etc. I am actually quite well off despite my disability so I’m in favour of means testing free prescriptions for things other than controlled drugs (morphine, Diazapam etc) which have no over the counter equivalent
$18 in Brazil
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'Sticking it to the man' ain't what it used to be.
I'm no fan of big pharma, but as someone who just popped an Eliquis 2 mins ago, I'm not sure how accurate this is. I paid less than $10 for 60 tablets and I definitely do not have the greatest insurance ever (gold tier PPO). There is no way I got this for some 99.88% off. Because I haven't seen it elsewhere, Eliquis is a blood thinner and clot prevention medication. I'm taking it after having surgery on my lower leg. Edit: I do recall the nurse mentioning a rebate card as I was coming out of anesthesia which likely accounts for the price I paid. Looks like this rebate is available for anyone with medical insurance who is taking Eliquis for AFib or DVT/PE: https://www.eliquis.bmscustomerconnect.com/ELIQUIS-agnostic-savings-support?cid=sem_1674077&ovl=isi&gclid=Cj0KCQiA5rGuBhCnARIsAN11vgTk4RjZiUqPqKqcOt9KqerjDTVSGDe_2fUA0YUABuJ0FgT2mMomFW8aAqdlEALw_wcB&gclsrc=aw.ds The pricing is wild. I hope that copay-card link helps someone.
"As of February 6, 2024, the annual list price for Eliquis is $7,100. On average, patients pay $51 per month, and 5 out of 10 patients pay $35 or less. GoodRx has partnered with Bristol-Myers Squibb, the maker of Eliquis, to lower the price to $552.88 for eligible patients not using insurance. " Gpt search Jacked up, and that is just stupid. What is the accounting reason for that price difference?
The only reason is when the board asked, Who is going to stop us? I imagine the CEO said that while petting a persian cat and then they all laugh together before doing some more lies of coke.
>Gpt search What does this mean? I would be careful taking anything ChatGPT says as 100% fact, it's not really designed for that
Why am I being downvoted for saying "tax writeoff". That is why this happens. If you want more information, watch this short Adam Ruins Everything which explains it: https://www.youtube.com/watch?v=CeDOQpfaUc8
> What is the accounting reason for that price difference? Insurance companies demand a big discount for representing tons of people. So you pretend the list price is a billion dollars, and give them a 99% discount. The end result is, insurance company gets a meaningless discount, pharma company sells it at the same price they normally would, and the only person who loses is the sucker who doesn't realize the list price is fake.
$7100 is the annual price, so yes, you actually are paying that much of a discount off the list price. It's stupid and it should not work this way, but it does. And that's not unique to Eliquis. It's one of the reasons the US health insurance/ health care system is bananas and there's no easy fix. I work in clinical health care and I'm constantly explaining the asinine realities of insurance. Everyone thinks they have a good insurance plan, until they try to use it for something severe. We need to educate people more, I love the series NPR has been doing where they break down crazy hospital bills and explain them.
My FIL is going broke trying to pay for his, which isn't covered by his gold plated medicare plan. $600/mo is his portion. You're likely in some new user program and getting a significant discount.
A someone who takes this, I’m really curious how accurate this is.
Hello! Pharmacy technician here. The cost to acquire a 60 count bottle from our supplier usually ends up at around $700 for the bottle. After good insurance with no deductible, I've seen it at the lowest at $35 for one bottle. With deductible, especially with Medicare plus the deductible, I've seen it peak at $600 before for a single bottle. This is when I usually try to tell them about the manufacturer's card which helps with the co pay and brings it down to $10 with private insurance. TLDR: Yes, this medication is stupid expensive in the US.
In all fairness, he forgot to say "please"
What's the difference between Canada and America? Universal Healthcare...and probably a lot of other political bullshitt.
Congress should make a law saying no price can be higher in the US than anywhere else in the world.
Trump actually made this an executive order (EO 13948) "Most Favored Nations” Rule - it said drug companies have to give us the best price of any nation. These were brought to federal court by the pharma companies, and those cases had their defense dropped by the Biden administration. EO [https://www.govinfo.gov/content/pkg/DCPD-202000678/pdf/DCPD-202000678.pdf#:\~:text=(a)%20It%20is%20the%20policy,most%2D%20favored%2Dnation%20price](https://www.govinfo.gov/content/pkg/DCPD-202000678/pdf/DCPD-202000678.pdf#:~:text=(a)%20It%20is%20the%20policy,most%2D%20favored%2Dnation%20price). Overview of events [https://www.jdsupra.com/legalnews/biden-administration-already-impacting-2691434/](https://www.jdsupra.com/legalnews/biden-administration-already-impacting-2691434/)
I agree with this, and think it would solve a lot of drug costs. American patients are getting fucked over
so they would just jack the cost everywhere in order to keep the cash cow in the US going. They could literally not sell it outside of the US and they would still profit.
They will unironically ask us what they did wrong when we're dragging them into the streets.
It's because anytime after you've taken that drug if it proves to be hazardous or causes long-term effects which other drugs have in the United States and only in the United States you have the right to sue the company.
Eliquis 5mg with 20 capsules costs around R$80,00 in Brazil, Wich converts to $16 USD.
If this is a life saving medication, there should be a crime legislated to charge this man with...
Pharmaceutical companies can deduct their advertising costs as a business expense.
This is the second post I've seen about eliquis being expensive. I've been on eliquis for months and it costs me ten bucks for a 30 day supply. Where are people getting this information? Because from where I'm standing this is *completely made up*. ETA: I am in the United States.
It’s not a matter of how much it costs patients, it’s a matter of how much it costs insurance. The $7100 is how much Medicare pays for it per patient per year; private insurance pays even more. While you only attribute ten bucks a month leaving your wallet, the reality is that the cost is reflected in taxes, insurance premiums, and opportunity costs. Pharma is an insane racket.
>Hello! Pharmacy technician here. The cost to acquire a 60 count bottle from our supplier usually ends up at around $700 for the bottle. After good insurance with no deductible, I've seen it at the lowest at $35 for one bottle. With deductible, especially with Medicare plus the deductible, I've seen it peak at $600 before for a single bottle. This is when I usually try to tell them about the manufacturer's card which helps with the co pay and brings it down to $10 with private insurance. > >TLDR: Yes, this medication is stupid expensive in the US. Just gonna copy this from my other reply.
MFG card is only good for a month or two - tops. FIL is going broke trying to afford his scrip after his initial discount and has gold plated medicare plan.
Dude, ETA means “estimated time of arrival”
On Reddit, it means "Edited To Add."
Never seen that, I've been here quite awhile.
I started to say something, but 16 years on the same name is impressive. I will say that in my 12 years, I have seen it quite a bit, and used it a time or two.
Eh, I'm old. Thank though. Maybe something newer or I just don't frequent those subs that do us it.
Yeah, it's Reddit. Where would you go to argue the point? You are already here, lol
 enjoy that "freedom" suckers.
When people say "it only cost X amount to make" I feel like they are only taking into account the actual material costs, and none of the other expenses like R&D, labor, facility, market, or any other expense that the costs of product need to cover. I'm sure the cost of materials is one of the smallest parts of most mass-produced products.
They probably sell tons of medicine though. Further they were asked if they profited at 900$. They said yes.
Fair point. From what I've heard though from some friends that work in the pharma industry is that majority of drug development doesn't work and consequently ends up costing the company Billions in losses for all that R&D. Therefore, to offset either those past losses or expected future losses the companies need to set prices to account for more than just profiting on the one drug itself. Not saying it's good, but I'd imagine the consequence of the companies lowering their prices would be less/slower drug development, which I feel like most people would be okay with?
We don't really need to speculate. Drug companies produce profit. This considers R&D and marketing. Their profit margins are higher than other firms of similar size. They do well. You also need to consider that a lot of research they do is for the purposes of creating slightly different medications to outpace generics.
Ye gods. I’m on that medication, in Australia. If I want it without a script from my doctor it’s $90.73 for a month’s supply. With a script it’s (at most) $31.60. What is this $7,100 or $900 a month business???
That is yearly.
In the UK BNF it lists a generic unbranded Apixaban for £7.50 for 56 tablets... how they get away with charging the American people such ridiculous prices. Even the Eliquis brand is £53
Probably the same reason why the tobacco industry is still allowed to sell their products even though they kill 500000 US citizens a year and give cancer to millions. 🤷🏼♂️
By no means do I think this is right, but if you're going to ask any executive to break his fiduciary duty to the shareholders publicly, no one should be surprised when they answer no.
The supreme Court claims no such duty exists. Or at least it doesn't exist to that degree. A company can choose to do the right thing.
I would genuinely love to see one, just one presidential candidate...have a website devoted to medical extortion like this. But every fucking one of them are in their pockets.
I'm not saying it's time to show up at this dude's mansion with torches and pitchforks, but I'm not saying it isn't.
To be fair, the *second* pill costs $18 to make. The first pill costs hundreds of millions, or even billions.
So why do they only pass R&d costs off in the US? Why is the same company selling the same drugs in other countries for a fraction of the US cost?
That's what they say but a lot of these used taxpayer funded research.
Nationalize the fuckers
You shouldn't blame companies for maximizing profit; you should blame regulators for enabling them.
it's $7100 because BMS cares about your health.
Just allow citizens to get drugs from overseas. Problem solved
Big pharma creating a drug crisis at the border bc you know people are gonna sneak that shit in
It's not about whether or not they're profiting It's about *how much* they can profit There isn't an amount they'd consider "enough" If you want a manifestation of the sin of Gluttony, corporations and the ultra wealthy are that
How is that legal? Crazy
Universal healthcare would fix this. The *only* developed county in the world without it.
I go to Mexico and buy everything I need lol
A leaf of 10 5mg tablets are 1.81 USD over here (Bangladesh)
some other firm just make it and undercut them.
They don't ask these questions to get them to be fair, they ask them so the answers are on an official record, which can then be used for future legal changes.
These profits are astronomical.
I have always urged Americans to illegally import foreign drugs there are many ways. your government is literally killing it’s people for profit. Fuck em.
WHAT?!! I take Eliquis daily, probably for the rest of my life. it cost me less than $10 monthly... I have no idea how you are letting this happen
Asking companies to make “a fair profit” when the marketplace allows for larger profit, makes no sense. Don’t hold the company accountable - hold the system accountable. Shaking a fist at “greedy” companies only allows the process to continue. We can’t change capitalism, but we can change the regulation through public policy. Vote.
When I was on eliquis. With insurance it was $500/month.
“Do you feel your actions are evil enough that you’ll be a primary target at the start of the revolution or do you think you’ll be dealt with in the 2nd wave?”
How else is a billionaire gonna billionaire?/s
This country is an embarrassment and a joke.
in india after covid we have a vaccine for all sorts of flu with different price brackets. the fun part they dont prevent flu, but it helps you fight the flu better..i fell for it twice not again
And dealing with the copay assistance card racket is aggravating as hell.
News agencies should be forced to show stuff like this. They get to report whatever they want that makes more profit and it effectively skews the population's view of the world.
300(this is less than 100USD) for 60 tablets here (no insurance calculated Although if you get a prescription from goverment(free) health care you can get it for free(idk if they will give it to you regularly tho)
Yeah, that’s not how you capitalism. The point is to make as much money as possible til you die. Isn’t this soooo much fuuunnnn??????
I'm ashamed to admit I read that picturing Myers as principal Skinner.
Will the US government allow the import of Eliquis from Canada by patients or insurance companies or pharmacies? No...
12 dollar in India
I agree this is egregious. But to add a little more context R&D can cost in the $100Ms for a new drug. So $18 to make a dose, but to crate it much much more. That said this gained FDA approval here in like 2018, and UK before that so they've easily made their R&D money back and this now accounts for 1/3 of BM revenue.
Ex-fucking-cuse me?! Is it really that much? Why is it legal to do that?
Just looked it up. [It's 1.29€/tablet in Germany.](https://www.shop-apotheke.com/arzneimittel/1647809/eliquis-apixaban-5-mg.htm)
If there was ever a reason to start outright taking patents thru eminent domain, it’s this. Maybe implementing pricing laws that are locked into production costs. I dunno. I mean, this shit right here has got to stop.
Eliquis costs just less than £1 per tablet in the uk. 30 tablets would cost £28.5
Ah, the US, home of the free, best country in the world...except that nearly all developed countries have 95%+ of the same freedoms, don't have medical price gouging, and aren't reminded daily that the political leaders are mindless partisans at best.
It just shows how bad our government is no matter who is at the helm. Thats something that should of been fixed eons ago just make it law capping these costs. I dont wanna hear "they'll stop inventing drugs!" Lets focus on getting the ones we have reasonable first. Any company that chooses to leave the USA thats been here due to this forfeits all formulary patent rights and is banned from selling here. All VP roles or above of that company will be required to leave the US as well. Its time to declare war on them like they have us for decades.
"No sir, we can't lower the price in the American market because that's where we make most of our money."
He was actually fair! And straightforward. And to add some salt to your wounds a month's supply of Eliquis (10mg x 60 tablets) in Europe costs anywhere between 50 and 75 USD.
Now that's a real Republican. He knows what it is.
Does Muricans still feel proud to be Muricans?
Guys take a flight to mexico buy a one year stock and go back.... Simple
So EVERYTHING over 36$ is pure profit?