The fact that this comes straight from a person in Real Estate is even more shocking. Does a plot of land in New York city cost the same as that in a suburb in Wyoming? No, and the price difference can be huge depending on the area in which you're buying. The same way, drugs are probably priced in individual countries based on how much revenue the company can generate. It might be the case (and is certainly the case) that there are too many rich people living in the US than in any other country. However, I'm suspicious about the fact that while these companies are not at all interested in getting poor customers in non-prosperous states in the US by lowering drug prices in specific states (by restricting their movement across states), they are certainly interested when it comes to bending the knee in front of communist regimes with much less population. The obvious solution is to deregulate the environment enough and getting rid of regulatory institutions to promote the growth of startups. Getting mediocre medicines for a cheaper price is much better than getting none. It also puts enough pressure on big pharma to lower their prices.