https://pubmed.ncbi.nlm.nih.gov/26817958/Another line of research would be PBMs (Pharmacy Benefit Managers). These are another primary means through which drug prices are manipulated by Big Pharma, away from public scrutiny. Some Big Pharma companies have actually formed their own PBMs to provide better secrecy.
https://en.wikipedia.org/wiki/Pharmacy_benefit_management
Understanding what's really going on, i.e., exactly how it works, would require reading and understanding a significant amount of case law or working for Big Pharma. Note that understanding how it all works will not necessarily lead to change, unfortunately. PhRMA does a reliable job of making sure things stay the same year after year. These problems with gaming Hatch-Waxman have been around since the 90's. IMO, Big Pharma's lobbyists are far more skilled than Big Tech's lobbysists. Time will tell.
There is no single factor that is wholly responsible for higher drug prices. It is many factors. This is probably why it is such a difficult problem to solve.
Here is one example of one Hatch-Waxman "loophole." This is the one with antitrust issues that I had in mind when making that comment.
https://en.wikipedia.org/wiki/Reverse_payment_patent_settlem...