> And that means those same drugs, from those same companies are now cheaper outside of the US?

Drug development essentially results in the creation of very expensive intellectual property. A wide variety of drugs are easy and cheap to manufacture [1].

The cost to develop a drug can range from $314 million to $2.8 billion [2]. Fewer than 8% of drugs make it through the development and trial process [3]. It's super expensive and risky.

Other countries do not have to respect US drug IP and can produce these drugs for near zero cost. They benefit from the expensive drug discovery and vetting that the US pharmaceutical industry perform and the US FDA requires, but they don't have to pay for any of it.

When countries do pay for US drug IP, they do a lot of strong arm bargaining. If this happened in the US, many of the drugs, especially for rarer illnesses, wouldn't be developed in the first place.

[1] Gene therapies, monoclonal antibodies, viral vectors, and other types of treatments not so much.

[2] https://pubmed.ncbi.nlm.nih.gov/32125404/

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10173933/

In some cases. But the point is other countries enforce lower prices, and they make up the margins in the US. On the one hand it is obscene but on the other we do see a pretty regular supply of miraculous new drugs. Something clearly needs done but the system does make sense (whether or not its optimal).