Wrong, the drug pricing in Japan is not based on the ingredients itself, it's based on what you can prove as an indication for a specific disease. Does not matter if you can mix off the shelf drugs to get the same drug. For example there are painkillers with prescriptions that contain the same drug than the OTC versions but are sold at a more expensive price.
> Since there is no bullshit expensive drugs,
You seem to have no idea what you are talking about, sorry, There are drugs that cost more than 1000 dollars per injection in Japan as well, and that are reimbursed. Oncology is full of such drugs, look at the highest pharma revenues in Japan, they are all coming from companies focusing on oncology.
> Rebate is prohibited
Rebate is happening between wholesalers and hospitals, and it's not unusual, it's the de-facto mode of operation in Japan.
> they switch to generic drugs on default unless patient strongly object not to.
Depends, if the doctor has prescribe the drug with the commercial name the pharmacist can't switch you to a generic. And generics are not equivalent to the original drug - the formulation matters, not just the active ingredient.
> The govt regulate the insurance so it's either all covered by insurance or nothing
You still have to pay out of pocket in Japan, while it&'s a fraction of the total cost (30% for regular employees, 10% for elderly people). It can still get fairly expensive if you add hospital nights and all. That's why you also have additional private insurances in Japan to get higher levels of reimbursement.
https://khn.org/news/article/medicare-ruling-aduhelm-controv...
https://hbr.org/2021/10/the-u-s-can-lower-drug-prices-withou...
Japan actually has a bunch of fairly major pharma companies that develop a lot of new drugs. You just don't hear their names in the US because the drugs get licensed to other companies when they're sold in the US and you only hear the name of the company that licensed them, but there are plenty of drugs that are commonly described in the US that were developed by Japanese pharma companies.
Local drug price regulations actually don't necessarily affect drug companies in a given country that much for this reason (they don't just develop drugs for the domestic market, and licensing to other countries to sell internationally is pretty much the norm).
However, in the case of the US it seems like the US pays a disproportionate amount of the total costs so it's possible that US drug price controls would affect pharma companies worldwide more than other countries' drug price controls. I'm not sure whether or not this can really be described as the free market doing a good job or not since the location where drugs are developed doesn't really affect their availability in other countries.
I dont have those stats handy, but given how unhealtht the American population is as a whole I dont expect that we'd end up on the better end of that comparison.
(As testified before a congressional committee by an FDA official, his response to the question of "how many drugs receive government research funding?" was "all of them.")
Where is the "always" coming from? Check actual clinical trials registries and you will see that most clinical trials are not funded by the government.
No, it was not.
US Tax Dollars Funded Every New Pharmaceutical in the Last Decade:
https://www.ineteconomics.org/perspectives/blog/us-tax-dolla...
How many new drugs rely on government-funded science? All of them:
https://www.cbc.ca/news/health/drugs-government-funded-scien...
The industry works all the time with academics. Academics do the fundamental science labor, which means identifying new targets, new pathways, new proteins and so on. This kind of research is indeed usually funded by a combination of public and private grants. Most of that research leads to nothing in the end, by the way - not everything they produce is picked up by the pharma industry, because most of what they produce fails to give results - that's the inherent property of doing fundamental research.
Then the industry purchases/licenses (and patents) what is considered to have the largest commercial potential - then pre-clinical, phase 1 up to phase 3 are mostly funded by the pharma industry. This is also where the bulk of the cost is. A clinical trial in phase 3 can costs in the dozens of millions of dollars, and there's always a solid chance that it fails to meet its endpoints so the risk is far from nil.
Based on the NIH numbers, the funding for research (i.e. grants) is about 45 billions annually. At the same time, the pharma industry spends 87 billions per year on R&D, which is about twice more.
1. The price of drugs are regulated. There is no chance such a bullshit drug just combining OTC ingredients are allowed to be sold with such a high price.
2. Since there is no bullshit expensive drugs, doctors don't need to worry about it. Rebate is prohibited, but even if it exists, you can't prescribe the drugs you can't use.
3. I'm not sure about the quality of pharmacy in Japan but they regularly call doctor when they have concerns about the prescription and they switch to generic drugs on default unless patient strongly object not to.
4. Universal Health Care. The govt regulate the insurance so it's either all covered by insurance or nothing.