Yup. I see three basic problems with the system.I would assume at least part of the high cost of the drug is in recover the high R&D costs in developing it. That said, it does seem excessive and out of reach for most consumers.
1) Consumer advertising. That should be extremely limited--there's a legitimate case for it in cases where there's a new treatment for a live-with-it condition that's a major step up from what came before. And it should be limited to advising people to talk to their doctor about a new treatment for X. No names. Off the top of my head Viagra would be the only case. (Since it's a live-with-it someone who found previous options unacceptable might have changed doctors and not mentioned it to the new one.)
2) Unjust negotiation involving formularies. Off the top of my head:
2a) Offering states substantial rebates on their drug if they'll make it the sole one in the class on Medicaid. The states decide the formulary, the feds pay most of the bill. The drug companies can make it economically sensible for the states to go with the expensive one, leaving the feds with the bill.
2b) Offering hospitals good deals for being the exclusive one on certain drugs. It's a lot easier for the doctors to switch patients to the formulary drug, now they're discharged on a more expensive drug. Some drugs aren't that easy to switch around without monitoring the results.
This isn't a coke-vs-pepsi situation, I'd make any such exclusive agreement illegal.
3) Runaway successes like the weight loss drugs. I'm not sure how to fairly address this one.
And, a related issue, I would make insurance company denials a medical decision. And the patient can bring a malpractice action as if the treatment were denied even if they actually pay for it another way. Damages are not limited to the value of the treatment but the value of the consequences. As it stands they have basically zero risk in denying care and that makes for very lopsided decisions.