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Comment by bastih | Hacker News Reader

Is there an analysis of "all" prices somewhere, maybe even combined with the sales numbers? Just as an example, some more common drugs like Ibuprofen are much more expensive in Germany. I get that we can always point to drug X or Y.

There's probably also an interesting conversation about effective cost: what does average Joe pay after taking deductions into account?

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But Ibuprofen isn't necessary for most of its users survival and is still much cheaper. More importantly, with both a social safety net and public health care close to no one in Germany will die because they could not afford medical care. So you're comparing a $10 drug that most people take against head ache, cramps or light pain with a drug that, where its unavailability will kill many diabetes patients within weeks or months.

Prices of basic drugs like ibuprofen, paracetamol or aspirin are a bad choice for comparison. They are so cheap that pharmacies will usually stock a brand (sometimes competing brands) that they can sell for higher margins. Also in Europe they are limits on how many can be sold at once without a prescription, so they are usually only sold in smaller packs compared to the US.

> some more common drugs like Ibuprofen are much more expensive in Germany.

What's stranger to me as an American living in Germany is that you can't get it at "drug stores" like DM, Rossman, etc. that are the equivalent of CVS/Walgreens, let alone grocery stores. You have to get it at an apotheke (pharmacy) that's a separate business. In practice that means it's both more annoying (due to more limited business hours) and more expensive. No going to Costco to get a bigass bottle of more ibuprofen than any one family could reasonably use here.

But you can order it online at Amazon, oddly enough, though it's still much more expensive than in the states, and it looks like the largest size on offer is 50-count.

I get that German society is somewhat more regulated than in the US, but I just don't see what's the threat with basic medicines like ibuprofen that necessitates them being sold at specialist stores.

Yes, this is a constant irritation here, presumably to protect the awful Apothekes, who have a protectionist guild, and also - shamefully - sell complete nonsense like homeopathy.

I normally stock up on OTC medication like Ibuprofen when I’m in the UK.

The idea was that you can talk with a professional pharmacist, help you set dosage, etc.

Sometimes doctors write a recipe that has to be mixed, and so the pharmacist can do that.

Of course since pharmacies are also for profit shops, this aforementioned role is less and less important, and there's a pretty constant push to make the publicly available (so doesn't require prescription from a doctor) drugs free to sell at any other shop. (Eg. 0-24 petrol stations.) Eventually that push will go through.

Even though ibuprofen is considered a basic medicine, it's still a medicine. Ibuprofen is not totally risk free and therefore needs to be sold by "professionals". Either way, Americans tend to overuse this drug as a pain killer for every little bit of ache they may have, which is dangerous. The first time I took ibuprofen was when I broke my arm with 12-13 for the first day. The next time was with 24 after I got a root canal removed.

"it's still a medicine. Ibuprofen is not totally risk free and therefore needs to be sold by "professionals""

I don't know if you're using medicine as an official term here.

There are plenty of things that are medicine like, plenty of things that aren't risk free.

Peanut butter isn't risk free if you're allergic to nuts. Honey isn't risk free for young children. Alcohol isn't risk free.

> Even though ibuprofen is considered a basic medicine, it's still a medicine. Ibuprofen is not totally risk free and therefore needs to be sold by "professionals".

This is absurd on its face. Even when I buy ibuprofen here, they still just sell it to me the normal way. They're not quizzing me about how much I'm taking or whatever. It's less convenient and more expensive for zero benefit.

The "bigass bottle" of Ibuprofen isn't available in Germany and won't be, the limitation in size (IIRC 50 pieces) and prescription-free dosage (400mg) is to avoid having too much of it easily available due to the side-effects on the kidneys.

The theory is that it makes you think twice if you have to visit the pharmacy all the time. They won't sell you 10 packages at once either. Unless you rotate pharmacies all the time, at some point they will notice and ask you to consult the doctor to root-cause the issue.

That's the value pharmacies (are supposed to) bring, and it shows in that they have pharmacologically trained staff, while those drug stores hire whoever is able to operate a cash register.

The reason for the high cost is not the fact that you can't by a 1000-count bottle -- it is the fact that German pharmacists form a cartel that is protected by laws that they lobby for extensively.

In the UK you also can't buy more than 32 pills of ibuprofen/aspirin/paracetamol at once without prescription -- but the cost is 1-2 cent per pill because every supermarket including ALDI can sell them.

You can buy non-prescription medications online, e.g. I regularly use https://apo-rot.de or https://docmorris.de for my bulk purchases.

Doesn't seem too bad...

https://www.deutscheinternetapotheke.de/ibu-400-akut-1a-phar...

That's 50 x 400mg for EUR 6,29 (USD 7, give or take, incl taxes).

https://www.walgreens.com/store/c/walgreens-ibuprofen-200-mg... is 100 x 200mg, so about the same, for USD 5 (plus taxes)

But in the US you also get much larger packages that just aren't available in Germany: https://www.walgreens.com/store/c/walgreens-ibuprofen-200-mg... is 1000 x 200 for USD 20, 10x the drug for 3x the price.

I doubt there's much market demand for 1000 quantity bottles of Ibuprofen in Germany. If you need daily pain killers I would expect the insurance to pay for (most of) them.

It was just for cost comparison: The "equal active substance" (50x400mg vs 100x200mg) package is already cheaper in the US, and they have those larger boxes that skew things even more.

So yes, there are drugs that are cheaper in the US. There's also pretty solid reasoning behind why you won't find the larger packs in Germany: if you're in need of that, go to a doctor instead of ruining your kidneys through self-medication.

Who would need 1000 Ibuprofen? Just take the good ones (800 or more) and one is enough if you go to bed after taking it.

edit: I mean, do you take those regularly? That might be the problem at all.

800mg is only available by prescription (of course, you could just take 2x400mg, but that means going to the pharmacy even more often, which works out as designed)

But how often do you need Ibuprofen, so this matters? I think I'm using much less than a small package per year.

I mentioned in the 1000pcs bottle for price comparison purposes.

Buy a 1000 pcs bottle, split up with 10 friends who get 100pcs each, split up the costs, save 4€ out of 6€ per person.

As a point of comparison. In the UK.

Tablets work out to 1.81p each (200mg) https://groceries.asda.com/product/ibuprofen/asda-ibuprofen-...

So £1.81 ($2.38) / 100 (according to google)

A generally healthy person may need a few Ibuprofen per year if any at all. Ibuprofen or Paracetamol are not M&M. And if you actually need so much painkillers you definitely should see a physician!

Ibuprofen and acetaminophen are not the same kind of compound. Acetaminophen is an analgesic (painkiller). Ibuprofen is not; it's an anti-inflammatory. It has more uses than just pain relief, and has different effects on the body.

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