Not a rip-off, but a consequence of lower regulations in the U.S. Through higher domestic prices you are subsidizing the lower prices in most other countries f

Not a rip-off, but a consequence of lower regulations in the U.S. Through higher domestic prices you are subsidizing the lower prices in most other countries for American-developed drugs. You are also subsidizing the R&D. A single drug can cost billions (with a "B") of dollars to develop, test, and manufacture. It takes years of experimentation and careful trials, and even after the chemical is approved by the FDA, there are hundreds of millions of dollars in liability insurance baked into the price against the almost inevitable class action suit should there be an unforeseen side effect. For example, Roche has developed an MS drug, ocrelizumab, which attacks B cells exclusively and appears to slow the progression of the disease. It's in stage 3 tests and has cost well over $1 billion so far. There is a large market for this treatment, should it ever make it out of the lab. The problem is, a side effect may cause the FDA to deny approval, and there is no particular compensation. Maybe they can use the knowledge to develop a better drug, or maybe it will help some other research organization. Either way, it's a very expensive and risky gambit. The way they recoup their costs is by charging a lot up front. Since Canada and other countries cap the prices they can charge, they can only do so in the domestic market. I'm not saying I approve of this approach. Frankly if I had MS I'd not want to wait 5 years for the FDA to declare it perfectly safe. I used to volunteer in an MS clinic and I can tell you, people were often willing to take the risk. Tysabri was another one that was amazingly successful against MS, but it also activated a rare and fatal virus in the brain in a very small number of patients, so it was pulled off the market. I've read that it's being allowed in limited cases.