Well, a few reasons... Much of the time, it is excess inventory or licenses which are sold to those countries - additional profit with little investment, and subsidized through sales to US customers.
Beyond, there is little ability in India, for example, for a massive multi-billion dollar class action lawsuit. And honestly, once approved by the FDA, almost any drug is automatically approved in other jurisdictions.
To me, the real solution involves this: A considerable amount of the sticker price for drugs is to cover the inevitable class action lawsuits that are to come. Instead, add a small tax to prescription drugs to go into a FDA fund which will pay ALL claims for any drug issues and put in stiff criminal penalties for any drug company that conceals or inflates any data from drug trials and reports after the drugs are released.
When drug companies no longer need a one to ten billion dollar contingency fund to cover future court claims, the prices will fall sharply. If you further make it illegal for drug companies to directly market to doctors, you cut costs even more dramatically.
Comment from the Ticker-guy:
“I’d give them a choice — either STFU or do 10 years for violating the Sherman, Clayton and Robinson-Patman acts.”
Sounds great in theory, and it might work. I just want to caution you that the two states that tried no-fault auto insurance on a similar basis both had / have by far the highest auto insurance rates in the country. On the other hand, it could be like worker's comp insurance, which might reduce the problem. But the plaintiffs' lawyers that own the democrats would never let something like this through. That's big money you're taking from them and they'll fight hard to keep it.