@freemo In case of USA it's unlikely because of patents, it's because of NDA enforced oligopoly on imports. I suppose the same insulin can be purchased for pennies outside of US.

Second popular technique of drug price boosting in the US is introduction of slightly modified variant of the same drug which *is* patented and then again using NDA to force doctors to move to the new, patented variant.

Both of these are only possibly because of active participation of NDA.