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.
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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, little has changed. When he was at Allergan, Bausch & Lomb’s current CEO, Brent Saunders, pledged “responsible pricing” but tried to extend patent protection for Allergan’s drug Restasis (another dry eye drug) through a dubious deal with the Mohawk Indian tribe, later rejected by courts.
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Now at Bausch & Lomb, Saunders oversaw Miebo’s launch, claiming earlier this year in an investor call, “We are once again an innovation company.” But finding a way to get an existing European OTC drug to be a prescription drug in the U.S. with a new name and a 40-fold price increase is not true innovation — it’s a price-gouging strategy.
Bausch & Lomb could have pursued OTC approval in the U.S., leveraging its expertise in OTC eye drops and lotions. However, I could not find in transcripts or presentations any evidence that Baush & Lomb seriously pursued this. Prescription status, however, ensures much higher prices, protected by patents and limited competition. Even insured patients feel the ripple effects: Coupons may reduce out-of-pocket costs, but insurers pay hundreds per prescription, driving up premiums and the overall cost of health care for everyone.
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