The US determines drug viability for the whole world:
Except in rare cases, pharmaceutical companies develop drugs for the U.S. market…. Probable success in America is a necessary and sufficient condition for the development of new drugs.
New drugs are very expensive:
In 2022, the inflation-adjusted fixed cost per approved drug is close to $7 billion…. While it’s true that foreign governments mostly free-ride on the enormous investments in R&D made by the U.S., it’s also true that somebody has to pay. If nobody pays, many treatments that would improve and extend people’s lives won’t exist.
The cost is worth it:
Research by Columbia University economist Frank Lichtenberg suggests that 73% of the increase in life expectancy that high-income countries experienced between 2006 and 2016 was due solely to the adoption of modern drugs. He also found that the pharmaceutical expenditure per life-year saved was $13,904 across 26 high-income countries and $35,817 in the U.S. Most Americans would pay $36,000 to live an extra year.