Another 3 (Rituxan, Avastin, Herceptin) are Roche drugs (Swiss), Advair is made by GSK (UK), and Lantus and Crestor are AstraZenaca (Sweden). None of these drugs are US, and their profits are not taxed as US corporate tax. Most of the drugs are imported. The three cancer drugs in particular (all made by Roche) are particularly expensive. All of this money essentially goes “offshore” from the US to other countries. The US consumer foots the bill.
Most other countries bargain with Pharma collectively (as Medicare cannot not). In Germany, all but the richest 10% of Germans are covered by state-run insurance programs, and all these programs (for the last few years) been able to bargain with drug companies to get a best German price. That price is now semi-secret, but the Germans are thinking of publishing it soon, which will cause all kinds of international hell. Except in Japan, where it’s no secret because the Japanese (being no fools) use the German prices as their baseline bargaining position for their own country’s socialized system, as to what THEY are willing to pay pharma. Again, Big Pharma can do this, because the EU market can be discounted after Pharma is done with the US. US sales are the tail that wags this dog.
Big Pharma and Germany and Japan (as well as the UK) can’t always come to an agreement on price. In those cases, these really expensive drugs are off the formulary for most citizens (Germany state insurance now won’t cover about 6 drugs total). Citizens in those countries can still pay out-of-pocket, but their state insurance won’t foot the bill.
The US consumer simply has to take it. This is increasingly the reason why your own insurance company will not cover your drugs. The prices they are paying are outrageous and if they covered them at US rates, you wouldn’t be able to afford the premiums. Or they do cover them, and you CAN’T afford the premiums.