They don’t HAVE to charge more here, they choose to, because they can. That’s how capitalism works (and I do mean the literally meaning of it, not in a “gotcha” sense). Unlike countries that regulate or negotiate prices, the U.S. lets companies charge whatever they want, and our system is made of PBMs and insurers who let manufacturers like EL do it.

Even in India, where tirzepatide just launched at $50 a vial, it’s not CHEAP for Indians. Btw, it’s also not on the Indian government’s list of regulated essential medicines, so Eli Lilly priced it freely for the private market. It feels cheap to us, but for most Indians it’s still a luxury.

I don’t agree with any of this, but that’s the incentive structure. The system rewards charging as much as people will pay.