Why is HGH so Expensive in the USA?

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HGH is way too expensive in the United States, but why?

We break it down here! As with any pharmaceutical product, there is the research and development required to create the product. This can be in the hundreds of millions of dollars for initial clinical trials in the USA. Once registration is completed and FDA approval is granted, it is much easier and less costly to get the same medication approved in smaller countries like Costa Rica and Mexico.

HGH is more expensive in the USA than it is in many other countries. This is because big-pharma sets their pricing models differently for U.S. residents. 

The same medications by the same manufacturers are often available in Mexico and Costa Rica for approximately 1/3 of the price. This is especially true for human growth hormone.

For the same medication in Mexico or Costa Rica, it is one-third of the cost for the same medication by the same manufacturer. 

See the example pricing table for comparable growth hormone produced and sold by Norditropin. We compare these prices between the U.S., Mexico and Costa Rica. 

Norditropin is FDA approved for growth hormone replacement therapy.  Please review the price table below for the estimated cost of growth hormone in your city versus our treatment centers in Mexico and Costa Rica. 

Click this link to see HGH Prices in the top 10 U.S. Cities. 

U.S. Drug Pricing CNBC w/ EQRx

EQRx January 13, 2020 Interview JP Morgan Health Conference. 

How HGH Prices Work in USA

Wall Street Journal Report on USA Drug Prices

Average Monthly Costs of HGH

USA HGH VS. Abroad Costs EXAMS/LABS MONTHLY HGH ESTIMATES
HGH Prices in USA $570.00 initial exams $1,295.00 monthly
HGH Prices in Mexico (TJ) $550.00 initial exams $450.00 monthly
HGH Prices in Costa Rica $550.00 initial exams $550.00 monthly

Note: Prices are close estimates based on typical patient averages. Minor rate adjustments may occur depending on dosage and any additional medications required. The typical patient will see a rate very close to those mentioned in this table.

Initial programs of 90-days minimum are generally recommended to observe measurable improvements in body composition, fat loss, energy levels, and exercise intensity.  We aim to see improvements in age-related chronic disease markers and longevity markers when the proper lifestyle of diet and exercise is followed once deficiencies are improved. 

Innovation Claims made by Big-Pharma

Historically, big-pharma has attributed high prescription drug prices in the USA to innovation. However, CNBC reported in Jan 2019 this may not be the case based on a new prescription drug study.

See existing product price inflation in the cost of prescription drugs

Essentially, in the case of brand-name drugs, rising prices were mainly driven by manufacturers raising prices of existing medications. This is not true for generic brands, but only for name-brand medications.

HGH is only available as a name-brand. No generics are permitted.

Norditropin HGH is a good example. At a CVS store in San Diego, the price of the Norditropin 10MG HGH injection pen is around $1,295.00. However, 25 minutes south of San Diego, in Tijuana Mexico, the same medication, by the same manufacturer (Norditropin) is only $450.00. That’s roughly 1/3 the price. 

From 2008 to 2016, researchers found that injectable medications like the Norditropin growth hormone increased on average 15% per year.

Other countries like Mexico and Costa Rica have been successful at keeping the price of these injectable medications much lower. This is the main reason we have placed medical tourism treatment centers in each of these locations.  

Unfortunately, the US government does not effectively negotiate drug prices for its citizens,  and there are very few competitors in the supply chain of HGH to drive down prices. 

This isn’t so in foreign markets. Governments negotiate directly with big pharma to drive costs down.

Without price transparency, many Americans remain unaware of this significant price difference between the USA, Mexico and Costa Rica

Politicians have been unwilling to take on big pharma’s exaggerated pricing model in the USA. They have hearings where that call big pharma executives in to testify, but little ever gets done.

It is unlikely the U.S. will see drug prices lower or on par with other countries. HGH prices in the USA will likely remain high for some time to come.

The HGH supply chain in the USA is as follows:

  • HGH is produced at a manufacturing site.
  • HGH is then transferred to licensed wholesale distributors.
  • HGH is then sold and stocked at retail pharmacies.
  • HGH finally is prescribed and shipped to a patient to alleviate a medical condition determined by a licensed physician.
Reportedly, the U.S. government began looking more closely at these price differences. But this is not something completely new. For years politicians have been complaining to big-pharma, but to date, we’ve not observed any significant price reductions for growth hormone therapy in the USA. 

US Senate Hearings on Drug Prices

Senate hearings on drug prices in U.S.

Key Takeaways:

  • US spends more on prescriptions drugs than any other industrialized country
  • Medicine produced in USA actually cost more in USA than in Canada, France and Germany 
  • Taxpayer in US pays for most basic research through NIH

President Speech on Drug Prices

Key Takeaways:

  • Tougher negotiation for lower US prices
  • More competition
  • Eliminating the middleman
  • Reduce lobbying by “Big-Pharma” and Insurers
  • Remove incentives to encourage high prices
  • Ban gag-rule which prevents patients from knowing drug prices

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HGH (Big Pharma) ManufacturersOligarchies

  • Only a few very large multinational firms like Novo Nordisk, Pfizer, Merck, Eli Lilly, etc. produce HGH.
  • The 10 largest Big Pharma companies (measured in US sales only) account for 60 percent of total corporate sales in all of the United States (2004).
  • Big pharmaceutical makers have the most influence on pharmaceutical prices (HGH prices).
  • Prices are determined by expected demand, future competition, estimated marketing costs, the other factors relative to what Big Pharma believes patients (customers) are willing to pay, relative to the benefit they receive.

HGH Wholesale Distributors

  • Wholesale distributors are the intermediaries who buy from the manufacturer and sell to the pharmacies.
  • Wholesale distributors in the United States have been undergoing consolidation, declining from approximately 200 in 1975, to fewer than 50 in the year 2000.
  • The top 3 wholesale distributors account for almost 90% of the wholesale market in the United States.

HGH Pharmacies – Little Incentive to Negotiate

  • Pharmacies negotiate prices with manufacturers and wholesalers, yet for most prescription medications this doesn’t reduce prices in the United States as much as it should.
  • HGH usually is distributed by mail-order specialty pharmacies due to its limited distribution throughout the USA.
  • Because of the insurance model in the United States, drug prices are inflated and pharmacies have little or real power to influence competitive pricing like in other industries due to poor oversight by regulatory authorities.

Anyone with some business knowledge can observe that the US pharmaceutical model is not effective at creating true competition. Over-regulation in healthcare and pharmaceuticals creates oligarchies. Oligarchies come from a form of government which functions in a manner where all power is vested in a few dominant persons or companies. With only 5-10 companies and 3 wholesalers controlling much of the USA-based pharmaceutical supply chain, it is no surprise why human growth hormone is so over-priced and out-of-reach for most Americans seeking its benefits.

 

Why is HGH so Expensive? – HGH Market Share Around the World and in the USA

The HGH Market nonetheless is a significant market in the United States and around the world. Important points about the HGH Market and why HGH is so expensive:

  • Total HGH market is estimated between 3-4 billion annually.
  • The HGH market in the USA is approximately 50% of that ($1.5B-$3B annually).
  • 50% of all sales are for children with growth hormone disorders.
  • 50% of all sales goes to adults – far above and beyond the “so-called” adult human growth hormone deficiency estimates. Hence, the majority of adults taking HGH are actually doing so to achieve the results outlined in many research studies like the famous Rudman HGH study.

Demand for HGH, even without insurance coverage for most creates $1B-$2B annual HGH business where the target market is adults in the US and around the world.

HGH Manufacturers Global Market Share Slide

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HGH Price - too expensive in USA!

Typically a growth hormone therapy program will cost patients seeking treatment in the Sacramento area $1,300 to over $2,000 per month. Premium HGH like the pre-filled Norditropin HGH Pen may even be more expensive. 

For premium brand HGH like Norditropin by Novo Nordisk, a typical adult patient will be looking at nearly $2000 monthly in the Sacramento metro area. See the recent US price level for HGH directly below.

Norditropin FlexPro HGH Injection Pen MX
Norditropin HGH NordiFlex Pen

HGH Price Comparison

Last updated December 2019

U.S. HGH Pricing Vs. Anti-Aging and Wellness TJ

CVS RX Norditropin HGH $1,312.18

Tijuana Mexico Anti-Aging and Wellness HGH $450.00

The rate for a Norditropin HGH pen which contains 10MG and 30IU of treatment is between $450-$550. For many undergoing HGH therapy as part of an HGH deficiency and age management program in the US, this is one-third the amount paid in the U.S.

The reason HGH is nearly 3-times more expensive in the United States than in Mexico and Costa Rica is the result of pricing models created by big pharma for a name-brand prescription drug sold in the USA. There is no difference in the medication. The medications are the same and from the same manufacturers.  

How Does One Qualify for HGH Therapy?

There are many factors that go into determining if HGH therapy is a good option for adult patients. Unfortunately for those living in the USA, it’s more determined by the size of the person’s pocketbook.

Many among the rich and famous are already using HGH for their own medical lifestyle choices. Some of these people include Suzanne Somers, Sylvester Stallone, and billionaire tech entrepreneur Peter Thiel

To qualify for a deficiency, patients must undergo comprehensive blood testing, a medical examination, and submit a detailed medical intake questionnaire.

Then upon meeting one of our licensed medical professionals, an appropriate age management lifestyle program can be discussed based on your baselines.

Should I Take Metformin on HGH Therapy?

Metformin is the first line of treatment for adult-onset diabetes and is used in some cases for prediabetics. Some doctors may use it as a weight-loss medication. It is currently being studied for anti-aging purposes by leading scientists. See <TAMES Clinical Trials> study. 

Famous Harvard anti-aging researcher David Sinclair (Comments on Tom Bilyeu YouTube channel) and others are taking metformin for age management, not as a diabetic medication. 

Dr. Sinclair also supplements with NAD+ (NMN) for its benefits related to longevity and mitochondrial wellness.  

Anti-Aging and epigenetics (Understanding Epigenetics NIH). Recently a small research study was published regarding key aging biomarkers being reversed by 2 years or more after taking HGH and Metformin over 12 months <Aging Cell – Reversal of Aging>, [Aging Cell – Reversal of Aging pdf]. 

We do not prescribe Metformin for anti-aging purposes. However, we do follow evidence-based research related to the standard American diet and its influence on glycemic variability and proper glucose control. 

Let’s face it, approximately 70% of the population is overweight or obese. Most of these patients are potentially near diabetic (prediabetic) or will be within a matter of 10-15 years.

Reference this one Japanese study on forecasting type II diabetes 10 years in advance. Other research going all the way back to the 1970s suggests the same thing. Detection of Diabetes In Situ, by Dr. Kraft, MD.

We approach health and wellness through integrative medicine. Our physicians pay close attention to various blood biomarkers which may indicate poor glucose control. In those instances, we will assess each individual’s health, and if they should undergo a strict lifestyle modification program. In some cases, Metformin may be a good option for the patient.  

Is it Legal for Me to Take HGH?

Our HGH programs are prescribed by licensed physicians in the US and abroad who use best practices for evaluating, prescribing and treating patients with HGH.

Our priority is on patient safety and optimal wellness. We do comprehensive blood testing, complete medical intake, and in-clinic exams.

Once it is determined between the patient and their doctor that growth hormone therapy can be prescribed, we continue to monitor, re-examine, and adjust protocols periodically to ensure proper treatment dosages, patient safety, and treatment efficacy.

Is HGH for Sale? Can I Buy HGH?

No, absolutely not. HGH is available by prescription only. Unfortunately, it is very rare for USA-based insurance companies to authorize reimbursement for HGH prescriptions in adults. Adult patients undergoing therapy will pay for their HGH therapy as an out-of-pocket medical expense, whether in the United States or at one of our international treatment centers. 

We strongly discourage patients from buying HGH from an international online pharmacy. Much of the growth hormone bought in this manner is likely counterfeit or not pharmaceutical grade HGH

Much of the generic HGH sold on the street is not 100% bioidentical. The risk of taking that form of HGH is your body may recognize it as a foreign substance leading to antibody resistance.

Your body can build a tolerance to it if it is not pharmaceutical grade HGH. Always use brand-name pharmaceutical grade HGH for any type of growth hormone therapy.

We only prescribe bioidentical growth hormone(s) from the leading pharmaceutical companies. These include companies like:

Growth Hormone and Anti-Aging

A new but small 2019 HGH / Metformin research study published in the Aging Cell journal has been making headlines in the news. Probably not since the landmark HGH study conducted by Dr. Rudman in 1990, has a single growth hormone study received so much buzz. 

Let’s first step back in time to the Dr. Rudman study released in 1990. This is when famous actors and actresses like Sylvester Stallone and Suzanne Somers began announcing their personal use of human growth hormone and other bioidentical hormones for age management purposes. Essentially the Rudman study determined the following <NEJM Rudman HGH Study>:

    • Men 61-80 years old injected HGH daily over a 6-month period.
    • No major adjustment to lifestyle was enforced.
    • Improved lean muscle mass of approximately 8.8% was measured.
    • The reduction of body fat was reduced by almost 15%, while their overall weight remained the same. 
    • Bone density increased by 7% or more.
    • Skin thickness increased by over 7%.

For the Dr. Rudman New England Journal of Medicine HGH Study <NEJM Rudman HGH Study>.

Now, researchers in California have observed key aging markers by reversing age by almost 3 years.

Researchers publish new anti-aging findings discovered when studying improving immune function. Treatment consisted of HGH, metformin, and DHEA.

These anti-aging therapies and protocols are unproven nor have they been evaluated by the FDA. This information is educational in nature. Always seek the advice of your physician before considering if this type of therapy is something you should consider for yourself. 

Is HGH from Mexico & Costa Rica Safe?

When HGH is prescribed by one of our doctors in the US, Costa Rica, or Mexico, the medication is safe. It is the same brand that is sold in the USA. All our HGH prescriptions come from major pharmaceutical companies. They come from registered pharmacies or distributors in their respective countries. 

Few, understand that they may be paying 2 or even 3 times more for their prescription medications than those who get their prescriptions from other us. A little known secret about prescription medications is that the United States pays more than other countries for the same medications by the same manufacturers. 

U.S. politicians from both sides of the aisle have “raged” about curbing the inflated prescription drug prices for years, but for some reason, nothing ever seems to get done. But you can do something about it.

You can get your prescriptions for HGH and other bioidentical hormone therapies from us at one of our international treatment centers.

We have both US and US-citizen foreign licensed doctors on staff in Tijuana Mexico and San Jose, Costa Rica.

HGH prescriptions are 60% less than the USA or in some cases 1/3 the price. 

Residents living in Sacramento who are prescribed HGH therapy are paying 2 or 3 times the amount for their prescription HGH each month. The same brands by the same manufacturers are available in Mexico or Costa Rica for about one-third of the price.

This page documents the unfair price disparity for this increasingly popular treatment modality for adult HGH deficiencies brought on by age and, in some circumstances, poor lifestyle.

We are a leading international age management group with treatment centers in the USA and abroad. We have US citizen doctors licensed in the US and in leading international medical tourism destinations like Costa Rica and Mexico.

We offer the best discounts for premium brand-name pharmaceutical HGH therapy like Norditropin, Saizen, Omnitrope, and Humatrope.

Some of our therapies in TJ Mexico are one-third the price as in Sacramento. This may impact tens of thousands of those prescribed HGH for a deficiency in the USA alone. 

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The Rudman Study on HGH & Why HGH is so Expensive

The Rudman Study on HGH is one of the most famous HGH studies to come out of the 1990s. 

It started the HGH hysteria among those searching for the fountain of youth. There have been many other positive HGH studies since them, but by far the doctor Rudman’s study was the one that set the HGH industry in motion.

However, before we get to the Rudman study, we first need to understand why it is important. 

The main importance of the Rudman study is that HGH helps reverse many of the metrics modern medicine uses to predict overall health and the development of age-related chronic diseases. Let’s address these in order:

Medical professionals and health researchers alike are taught and understand that body mass index and hip to waist ratio directly correlate with diminished health and development of chronic diseases like Heart Disease, Diabetes, Stroke/Hypertension, Cancers and more. If there is one thing in the research HGH does, it is it improves body composition.

 

Body Composition - Dr. Rudman Study 1990 HGH Therapy

Below are bullet points on the Rudman study:

  • Treatment was given for six months.
  • Ages ranged from 61 to 81 years.
  • Men were injected at 8:00 AM, with intervals between HGH injections only 1 or 2 days.
  • The men followed a healthy diet directed by a dietician.
  • The study found no significant change in body weight.
  • Lean body mass increased by 8.8%.
  • Fat decreased by 14.4%.
  • Skin thickness increased by 7.1%.
  • An increase in bone density of 1.6% was observed.
Dr. Rudman HGH Study - why is HGH so expensive?

Open a copy of the Dr. Rudman research paper here: <NEJM Dr. Rudman HGH Study pdf>.

What's the Most Popular HGH Brand and Its Cost?

Norditropin is the most popular and most prescribed brand of HGH. It is manufactured by Novo Nordisk. The company is headquartered in Denmark. Novo Nordisk is a global leader in diabetic and human growth hormone medications. 

Norditropin FlexPro HGH Injection Pen MX

Tech billionaire and biotech-longevity investor Peter Thiel wants to live to or beyond 120 years. He eats a Paleo diet, avoids sugars, and is taking human growth hormone treatment.

When should HGH be Prescribed?

This video is a reasonable argument related to the replenishment of HGH replacement therapy in adults.

Dr. Klatz of the American Academy of Anti-Aging and Regenerative Medicine discusses the modest and appropriate replenishment of HGH deficiencies just as one would do for thyroid, estrogen, testosterone or any other deficiency. 

Dr. Klatz discusses how it is a safe therapy and has been used safely for more than 50 years throughout the world. 

HGH is a naturally occurring hormone produced within the brain by the pituitary gland.

HGH to Lose Weight, USA Overweight – Obesity Epidemic

HGH helps reduce fat. It encourages fat loss and muscle gain. 

HGH does not make huge muscles in women, just solid healthy muscle tone.

Note that the NIH reports that overweight/obesity in the United States is impacting approximately 70% of Americans, and it’s only getting worse.

In general, people are healthier when they have less abdominal fat, body fat in general, lean muscle tone, and can more rapidly regenerate damaged cells. HGH has been shown to assist with the key pathways to foster healthy cellular regeneration. 

No one is suggesting HGH should be abused. Deficiency of HGH should be taken much more seriously in aging adults. 

One reason HGH is so expensive relates to obesity.

FAQ for HGH and Schema 1.0

No, it is not illegal to use human growth hormone with your doctor's prescription.

HGH is an approved medication for certain medical conditions such as an HGH deficiency. It must be prescribed by your doctor.

Border patrol, as well as the FDA, require international travelers to carry their doctor's prescription and keep the medication in its original packaging.

Please see: https://www.antiagemedical.com/why-is-hgh-expensive-usa/

No, it is not illegal to use human growth hormone with your doctor's prescription.

HGH is an approved medication for certain medical conditions such as an HGH deficiency. It must be prescribed by your doctor.

Border patrol, as well as the FDA, require international travelers to carry their doctor's prescription and keep the medication in its original packaging.

HGH begins working almost immediately. Most long-term improvements are seen within 3-6 months.

Men given HGH from ages 61-81 were given HGH over a 6 month period. At the end of the six months, they had approximately 15% body fat loss, an 8.8% increase in lean muscle mass, and an increase in bone mineral density.

A typical month's supply will cost $450. The same HGH from the same manufacturer in the USA will cost 3 times more.

The leading brand of human growth hormone now in Mexico and the United States is Norditropin.

Norditropin is the only leading pharmaceutical brand of growth hormone that comes premixed.

It can go 14-21 days without refrigeration due to the proprietary preservation technology of Novo Nordisk.

Most adults on our program range between 1-2 IU between 3-5 days per week.

Common protocols call for one daily injection each evening 5-days per week. However, some research shows similar benefits may be achieved from a less frequent dosing schedule of only 3 days per week.

Most adults on HGH replacement therapy will settle in between 1 and 2 IUs for each injection.

HGH is further enhanced by following an intermittent fasting protocol.

And for those who may be overweight and have some degree of insulin resistance, metformin may be prescribed. Berberine is also a good over-the-counter substitute.

Most individuals on a 3-day injection dose will see a slower degree of fat loss. But when combined with intermittent fasting, metformin, and/or berberine, results on fat loss will accelerate in most individuals.

A one month supply of prescription HGH in Costa Rica will cost approximately $550 USD per month for Norditropin Growth Hormone.

HGH in the United States generally is three times the amount in Mexico, Costa Rica and Panama.

Typical price for one month's supply of HGH at a U.S. pharmacy is approximately $1,250 USD.

Only name-brand (non-generic) versions of growth hormone are legal. Name-brand prescription medications are generally always 3 times more than in other countries because of the retail price set by large pharmaceutical companies and middle men known as Pharmacy Benefit Managers (PBMs). See our video at the top of this page.

Yes. As long as you have a prescription. If you are traveling internationally you will want a letter from the doctor. We have all of the legal paperwork from the major manufacturers so if TSA or US Border Patrol is concerned, you can show them the information.

Keep in mind, according to the Center for Disease Control, most adults over 40 years of age are on 2 or more prescription medications. International travel would cease to function if you were not afforded the basic human right of crossing borders with your prescribed medications.

Always carry your prescription and your letter from the doctor to avoid confusing border professionals and TSA.

We only prescribe name-brand pharmaceutical HGH from major manufacturers.

In the modern era with Google search and social media these black market online internet pharmacies are rapidly exposed.

We use real doctors and we promote our doctors. You get to know them and they get to know you. They are professionals and they want you to be healthy so that you tell others about our services.

Unfortunately, the United States health care system is broken. It's too expensive for insurance. Insurance focuses way too much on acute injury care instead of metabolic wellness to reduce age-related chronic disease like heart attacks, cancers, and strokes.

We operate very openly on the internet and through promotional material like print media. We've advertised in Airline Flight Magazines, major Newspapers and on Television. We've been caring and treating medical tourist since 2013 from all over the United States and Canada.

We only prescribe the same FDA approved pharmaceutical HGH brands that you find in the United States. The only difference is the USA must pay 2 or 3 times the price. Why? Because of big pharma's global pricing models and the problematic insurance model which exists in the United States. Both Republicans and Democrats have demonized big pharma for its inflated pricing, but nothing ever seems to get resolved. 

Recently, some states have begun to take action. Utah recently passed "Right to Shop" legislation which allows its public employees to buy legally lower-cost prescription medications in Tijuana Mexico. Click the link. It is widely reported in some of the press. Other states are looking at similar legislation: . Mexico has very good control of their legal prescription drug programs. 

We work closely with only the leading pharmaceutical companies. The process has a complete and safe chain of custody when it comes to name-brand prescription pharmaceuticals. 

No. HGH is not an anti-aging medication. What HGH does is it supports the growth pathways in support of normal energy metabolism.

Growth hormone works closely with the regenerative growth cycle of your body. However, it is now much more understood that this energy state is not ideal 100% of the time.

In order for patients to see the best benefits related to anti-aging at the cellular level, they need to understand what the research on longevity and aging shows.

The body operates best with it goes through natural anabolism and catabolic states (i.e., feast and famine). This reproduces a growth, cleanse phase at the cellular level.

HGH used in combination with metformin, and DHEA, did show an age reversal in epigenetic markers. The research was published in 2019. It is linked to on this web page.

However, we think this study can be improved upon by mimicking some of the new research by Dr. Sinclair of Harvard and Dr. Valter Longo of USC. They both promote the benefits of triggering mechanisms that influence AMPK and mTOR. To key elements of the longevity pathways. They do this with time restricted feeding and in some instances metformin.

Currently nearly 590,000 Americans die each year from some form of cancer. What doesn't give you cancer?

Probably one of the most associated element we would guess is related to cancer is poor energy metabolism.

One of the major reasons HGH is criticized for potentially promoting cancer in adults is that it increases IGF-1. Elevated IGF-1 is often associated with those with cancer. It's an insulin like growth factor, so for a tumor, it is simply assumed its going to feed growth.

To some extent, we agree. In an overfed, processed-food rich lifestyle, with poor glucose regulation, we think it is a reasonable fear people should have. But with that said, if you follow the recent works of researchers into aging and longevity like Dr. David Sinclair and Dr. Valter Longo, you learn that we need to be attentive to the AMPK/mTOR pathway.

If you go to our Metfomin Blog page, you can learn a little about this pathway as well as how metformin is being studied as an anti-aging drug because of its ability to regulate this pathway for those eating and living the standard American lifestyle.

Our goal is to help you understand as best you can what modern science is saying about this and its role in cancer. We are no longer living in the 1990s and this information is much better understood than ever before.

With that said, we recognize there is much more research required to draw any conclusions. What we can say is that cancer is a big problem in the world, especially the United States. Those who are in better shape, have a better body composition, and have excellent blood markers are less likely to get cancer. Our role as a medical treatment center is to help you achieve this goal. We want to see your risk factors for all these age-related metabolic diseases decline.

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