December 5, 2025
Cry me a pricey river
A $20 drug in Europe requires a prescription and $800 in the U.S.
From $20 to $800: outrage, safety panic, and insurance debates
TLDR: The same dry-eye drops cost ~$20 OTC in Europe but $800 as a prescription in the U.S. Commenters blast price-gouging, argue about PFAS safety, and counter with “list price” caveats—while noting high prices still raise premiums and asking why regulators didn’t allow an OTC path here
The internet saw the $800 U.S. price for Miebo (dry-eye drops) versus ~$20 OTC in Europe, and promptly set itself on fire. The loudest chorus: price-gouging. One user snarked it’s “extortion,” while another asked why eye meds always seem to have the slimiest tricks, citing Allergan’s infamous patent handoff to a tribe for immunity link. Meanwhile, Bausch & Lomb’s “we’re an innovation company” line drew eye-rolls the size of saucers.
Then came the plot twist: safety drama. A top comment flagged that Miebo/EvoTears is “pure PFAS” (a chemical class linked to environmental concern), delivering a dose “a million times” higher than drinking-water limits — yet still “revolutionary” for dry eyes. Cue split-screen reactions: half shouting “no thanks” to forever chemicals, half saying “finally something that works.” The money angle got messy too. One commenter argued “nobody actually pays $800” because it’s a list price insurers negotiate down, plus savings cards. Others clapped back that high list prices still jack up premiums for everyone. Curious minds asked: if Europe required a prescription, would it still be cheap?
Memes flew: “EvoTears? More like EvilTears,” “Eye-phone pricing,” and “import your tears” — with the crowd agreeing the real innovation might be renaming it and charging 40x more
Key Points
- •Miebo costs around $800 per month in the U.S. as a prescription; the same formulation (EvoTears) is OTC in Europe for about $20.
- •Bausch & Lomb obtained U.S. and Canadian commercialization rights for NOV03 in 2019 and pursued FDA prescription approval rather than OTC.
- •U.S. retail listings show Miebo at $830.27 (Walgreens) and $818.38 (Amazon Pharmacy); prices rose 4% in 2025, per 46brooklyn.
- •Miebo generated $172 million in 2024 sales and is forecast to exceed $500 million annually.
- •A 2021 RAND study found U.S. drug prices average more than 2.5 times those in 32 other developed nations; Bausch & Lomb cites FDA NDA requirements and extensive trials for Miebo.