Also, collective negotiation. The whole of the British National Health Service buys drugs and medical devices through a single process, as do most other nationalised health services. The NHS are particularly good at price negotiation and the prices they pay are publicly available[0], so other health services frequently use them as a basis for negotiation.

The fragmentation of the American healthcare system diminishes negotiating power, and creates perverse incentives between the people who buy drugs, the people who authorise that cost and the people who ultimately fund the system.

[0] http://www.drugtariff.nhsbsa.nhs.uk/#/00241786-FA/FA00241713...