It's not black and white. The US is particularly screwed because of loopholes in regulations that drug companies started exploiting in the late 90s to advertise

It's not black and white. The US is particularly screwed because of loopholes in regulations that drug companies started exploiting in the late 90s to advertise direct to patients (illegal almost everywhere else). So you've got drug A which is going out of patent and A' which is A with something hanging off it that's harmless but counts as novel. So you switch gears and put all your marketing behind A' (including cherry picked studies). You can produce A cheaper than anyone else, but you don't have to. Anyone trying to enter the market with A risks you undercutting them, and meanwhile you're marketing A' against A.