Lots of reasons. One of them is that other countries negotiate deals country wide and can get bulk discounts. The US does this with the VA and Medicare, and people using those services generally pay less than the rest of Americans. In the end, it is largely a policy choice, as having a single payer could get better negotiated deals on drugs.

https://www.healthsystemtracker.org/brief/how-medicare-negot...

"If Canada is getting a 30% discount we can make it up by baking it into the hundreds of smaller negotiations with American providers."

Drug maker thinking

Nobody's forcing US pharama companies to sell to those countries at those prices, they choose to, because it makes them more money.

Foreigners aren't the reason American healthcare sucks. Stop looking for people to blame abroad, all the sources of your problems are in the presidency, congress, and in the boardroom that directs the former.

Americans really love to tell themselves they are paying for others. You victimize yourselves, and then blame externalities. Fix you own issues.

This is not like IT where the Americans are completely dominant and clearly superior.

The European pharma companies are doing more than fine, despite their main market being heavily regulated and price-controlled.

The less charitable explanation is that US companies want to charge outrageous prices, and the American system let them to, so they do it.

That's what the USA are: a machine to prioritize profits over people. Sometimes it turns out fine, like for the startup scene. Sometimes it's terrible, like when lives at stake.

Other explanations sound like heavy copium to me.

Because US voters prefer the free market as opposed to government regulation and nationalized healthcare.

If you pitched a pharma company with the thesis of "We'll charge US customers less and global customers more", what would stop that from working?

I can think of a number of things.