The situation in Germany is way better than in the US, where these negotiations are a lot more favorable to the companies, because they can "negotiate" with individual insurance companies and even patients. But especially in the latter case, there's not a lot of "negotiation"...
So even here, where the system is probably better then in the US, it could be improved massively via regulation, without killing all profits or even the investments on R&D by the companies.
But the political will seems to be missing.
But dev a "new" cancer drug and you got your license to print money (lot of people get cancer, a lot is payed by insurance, and people and their loved ones want healing).
Also you probably underestimate the value and purpose of pharmaceutical regulation. Most rules revolve around production quality, scientific soundness, safety monitoring and so on. Come to think of it, the degree of safety in pretty much any drug on the legal market is quite astounding, despite exceptions and accidents.
Take Europe for example. As far, as I know in Germany the producers can pretty much dictate the price (ok, the have to discuss with the insurance companies, but they just can raise their fees so they have no real interest in saving money). After the German price is decided neighboring countries (Belgium for example) take these, cut of about half of that and dictate this as the maximum price for the drug.
Looking at the financial statements, the regarding companies still make a lot of money in Belgium of these drugs. But way more in Germany.
So I really do not believe the story being told, that the R&D costs and the risk are the reasons for these astronomically high prices.
And - when your life is at stake, your are more then willing to pay every price necessary - so your bargaining position is not quite great and your market power is drastically lowered.