You talk as if the negotiated prices were permanent. The profit extraction flows like water - if most customers negotiate lower prices, then the one market that

You talk as if the negotiated prices were permanent. The profit extraction flows like water - if most customers negotiate lower prices, then the one market that doesn't (the US), ends up carrying the bulk of the profits. If the US closes down the allowed margin, the drug maker isn't just going to blink out of existence. I would expect a set of renegotiation between all it's existing customers to rebalance what is a reasonable profit to allow - which admittedly would likely be lower than what is extracted from the US market currently. But that is likely healthier for society in the long term as it would remove all the costs of inefficiency spent on this crazy drug pricing dance that occurs in the US.