many major pharmaceutical companies (like Novartis, Roche, or Sanofi) aren't even American While true, their ability to charge so much more for the drugs they

many major pharmaceutical companies (like Novartis, Roche, or Sanofi) aren't even American While true, their ability to charge so much more for the drugs they produce in US markets make them much more profitable than they otherwise would be. Money that they in theory can spend on innovation. Of course this leads them to prioritise drugs that are primarily targeting rich Americans and which in turn leads to your second point.