And a lot of this is administrative overhead. Coming from a country outside of the US, I was also shocked by the price of medecine, every medecine magically seems to be 5-10x more expensive in the US.
The real reason drug prices are astronomical in the US is because the US government is legally prohibited from negotiating drug prices. So the pharmaceutical companies can literally set any price they want.
You don’t have this problem with certain government agencies that are exempt from this prohibition. For example the VA can often acquire the drugs for much cheaper.