Along with several million, I suffer from the eye disease known as glaucoma. It can be managed, rather than cured, by taking eye drops several times a day. Based on the advice of my doctor, I rely on Azopt and Lumigen, two drugs produced by leading pharmaceutical companies.

A week ago, prior to an international trip, I stopped at a local pharmacy to renew my prescription of Azopt (produced by a Texas company Alcon that manufactures 86 drugs) because I feared that my supply would be exhausted during the trip. A day later the pharmacist called me back to say that my insurance would only cover the refill in mid-March when according to their records I should have finished the supply I had, and would be entitled to more. She added that the for 15 ml. of Azopt without insurance I would have to pay $445, which is double what it would cost after the insurance kicked in. I thanked her for letting me know this bad news, saying that I would wait until next month.

Of course, I was upset as I really depend on the medicine. My eye doctor reminds me on each visit that if I am not diligent about the daily dosage of drops, I risk blindness, but to pay such an amount seemed exorbitant, and besides, I was heading for countries where such drugs could be obtained more cheaply without even requiring a prescription. The U.S. puts no limits on drug prices, and unscrupulous pharmaceutical companies charge whatever they believe the market will bear.

But I was in for a surprise. In the small Italian village of Bellagio I stopped at the first pharmacy I could find, asking nervously whether they had Azopt in stock. Sure enough a 10 ml. bottle was produced, and I asked for a second one.

The combined price for 20 ml. was 21 Euros, or about 35 times cheaper than what I was told I had to pay in California! It was not even a generic version, but came in the same bottle.

I do not have a precise explanation of this extraordinary price differential. It seems to reflect the machinations of the free market as operative in the United States, combined with the inelastic nature of demand, possibly due to absence of alternatives in the American market.

For me this experience was disturbing but never disastrous. I could travel to where the drugs were more cheaply available, or if necessary, pay the ransom prices being exacted on the American market. What distressed me was all those in need of such medication who were not engaged in international travel and lacked the funds to cover payment were being put in an intolerable position.

I am not sure what the explanation is for such gigantic price gaps, but it seems like a metaphor for all that is wrong with a world economy that lacks mechanisms of societal conscience to protect the vulnerable.

There are, of course, two kinds of related problems. The first is the gap between drug prices on the American market and prices elsewhere, and the second is the seemingly outrageously high drug prices on the American market where Azopt, even if covered by insurance, would still be $223 for a 15 ml bottle, sufficient for a couple of months.

What should be done? Make Bernie Sanders electable? Seek a social revolution? Does this require a global remedy, replacing neoliberalism with ‘social democracy’?

Surely something should be done!

---