Fundamental: the patents produced by taxpayer-financed academic research have no business being exclusively licensed to some pharmaceutical corporation. As far as the cost of clinical trials being borne by those companies, well, let's get the FDA involved in the clinical trials.

Then the competition can come in, i.e. whoever can produce pure preparations of those drugs at the lowest cost will win the most market share. This means investing in top-of-the line manufacturing platforms (much of this is now outsourced to India, Mexico, etc. for drugs being sold in the USA) instead of squatting on the patents, blocking competition, and using monopoly status to jack up prices.

Yes, this would greatly reduce the profit margins and perhaps the stock prices of Big Pharma outfits, but the overall benefits would greatly outweight this. As a practical example, look how the best Covid vaccines (mRNA types) have been monopolized, leading to low rates of vaccination in Africa etc., even though that was technology developed with taxpayer funding at public universities.