In the US healthcare system, there are 3-4 middlemen who take a cut, so the price the consumer (or their insurer) pays has little to no relation to the price the drug manufacturer gets.
There's an excellent podcast episode by Acquired about Novo Nordisk, the insulin company that also produces Ozempic. At 3hrs 45mins, it's not for the faint of heart, but I haven't heard a better insight into the US pharmaceutical market and why costs and pricing are so out of control.
https://www.acquired [dot] fm/episodes/novo-nordisk-ozempic
(It's obviously on apple podcasts and others - just search "Acquired Novo Nordisk" and it will arrive.
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