The same molecule costs $50 or $1,500 depending on the label on the vial

A 90%-cheaper path to repurposing old drugs — and the asterisk pharma leaves out

King's College London reports that hospitals and universities can run late-stage clinical trials of existing drugs for new uses at less than 10% of what the pharmaceutical industry spends — a roughly 90% saving. The logic of the gap: once a drug loses patent protection and goes generic, companies stop funding the search for new indications, because there's no monopoly left to recoup the trial costs. Academic medicine then picks up the cheap generic and tests it anyway.

The research, led by King's and published in the Cambridge Law Journal, points to real cases: a cancer drug repurposed against a leading cause of blindness, a breast-cancer drug turned into cancer prevention, an old anti-inflammatory used against Covid.

The blindness example, decoded by someone who works the clinic

The press release's "cancer drug to treat a leading cause of blindness" is abstract. A commenter who works with ophthalmologists filled in the names, and the part that makes repurposing hard in practice.

"Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs … Avastin costs about $50/dose, and Lucentis costs around $1,500/dose." — a commenter who works with ophthalmologists

The same voice supplied the catch the cost-saving story omits. Compounding pharmacies repackage the $50 drug for the eye, but that step introduces contamination risk:

"I know at least one ophthalmologist who … cultured a sample from every batch … and had at least one batch that cultured bacteria." — the same clinician, on a real contaminated batch

Untreated, that batch could have caused endophthalmitis — an eye infection that can end in lost vision. The $1,450 saving and a small but real infection risk sit on the same decision.

Why the cheaper truth often can't become the legal one

If academic trials prove an old drug works for something new, can patients just get it? Often, no.

"There is no regulatory pathway to extend the use of existing drugs for new indications … without the consent of the manufacturer. … it can't be an officially allowed usage." — a commenter on the regulatory dead end

A patient on Spravato (esketamine) gave the mirror-image version of the problem: a company tweaking an off-patent molecule precisely to re-patent it.

"They did this because ketamine is off-patent so they needed to modify it in order to patent it … my insurance company pays about $17k a month for this treatment. Ketamine would be a more effective treatment that would be super cheap for them." — a patient currently on esketamine

The fix nobody funds because nobody owns the result

The deeper point the thread converged on: the system rewards the molecule someone can fence off, not the one that works. A supporter of a rare-disease repurposing nonprofit explained why pharma sits these out entirely.

"For a disease like this, it's never going to make sense for major pharmaceutical companies to invest the effort to develop entirely new drugs, but by repurposing existing drugs, it gives people living with rare diseases a chance" — the author of a science book, supporting a Huntington's repurposing charity

One commenter pushed it to the policy edge: fund the trials publicly, drop the exclusive IP, and let manufacturers compete to make the proven drug cheaply.

"Once a clinical trial is complete, private manufacturers can compete to produce the drugs at the lowest price … against a final product standard regulated by the FDA." — a commenter proposing publicly funded trials

King's frames its finding as good news — academia can do this work 90% cheaper. The thread's correction is that cost was never the binding constraint. The constraints are a regulatory pathway that needs the manufacturer's blessing, a packaging-and-liability gap that keeps the cheap drug out of the clinic, and an incentive structure where no one pays for a result they can't own.