> Because it seems to me that the price difference is so large, sometimes by a factor of 10 or more The approval process is O(1%) of the total cost of developm

> Because it seems to me that the price difference is so large, sometimes by a factor of 10 or more The approval process is O(1%) of the total cost of development. > I also think if there were drugs that only exist because of high US drug prices that we would hear about them Maybe. I've grown wary of reading too much into the relative popularity of different phrases and arguments; it turns out people are complicated and prone to prioritizing points you might not care about, and even when those arguments are being made they often get lost in the noise of 8B other people. Humira probably isn't a bad example in any case (though without being inside a company it's hard to know for sure since you don't know if, e.g., they would have prioritized international approvals and sales if the US market couldn't be lucrative). Total international sales only eclipsed total R&D in the last few years, despite the drug having been around for a couple decades. I personally think the current level of price gouging for Humira in the US is excessive, but AbbVie would also have had to take a loss on it for nearly 20yrs without some level of price gouging somewhere.