Imagine this: You need a life-saving cancer drug. In China, it costs just $280. In the U.S.? $8,892. Same drug. Same dose. So, what’s going on?

A Tale of Two Price Tags

The drug in question is Toripalimab (Loqtorzi), a PD-1 inhibitor developed by China’s Junshi Biosciences. PD-1 inhibitors are a class of immunotherapy drugs used to treat cancers by blocking the PD-1 protein, helping the immune system attack cancer cells more effectively.

Toripalimab is widely used in China and other markets at affordable prices. But in the U.S., the same drug comes with an astounding markup—over 30 times its cost in China. This stark price difference exposes the fundamental flaws in the U.S. healthcare and pharmaceutical pricing system.

1. The U.S. Lets Pharma Set Prices—China Doesn’t

China’s government directly negotiates with pharmaceutical companies to keep drug prices in check. The National Healthcare Security Administration (NHSA) conducts centralized procurement and price bargaining to ensure that critical drugs remain affordable. This system forces pharmaceutical firms to lower their prices significantly if they want to sell in China’s massive market.

The U.S., however, operates under a starkly different system. Unlike most developed nations, the U.S. government does not negotiate drug prices for the general public, allowing pharmaceutical companies to charge whatever they deem profitable. They justify this with claims of research and development costs, regulatory expenses, and market factors. However, numerous studies have shown that these high prices have more to do with profit maximization than covering actual costs.

2. The U.S. Healthcare System Bloats Drug Prices

Unlike China’s simplified and state-regulated pricing model, the U.S. healthcare system is layered with middlemen, including:

• Pharmacy Benefit Managers (PBMs): These third-party administrators negotiate drug prices and rebates but often inflate costs instead of reducing them.
• Health Insurers: They add administrative costs and determine coverage, sometimes rejecting cheaper alternatives in favor of more expensive branded drugs.
• Hospitals and Healthcare Providers: Hospitals mark up drug prices, especially for uninsured patients, further increasing the financial burden.

A 2022 study by the Rand Corporation found that U.S. drug prices are 256% higher than those in 32 other high-income countries. This pricing model does not reflect actual manufacturing costs but rather a web of profit-seeking intermediaries that drive up costs at every level.

3. Coherus BioSciences Chose Profits Over Affordability

Toripalimab is marketed in the U.S. by Coherus BioSciences, a California-based biotech company. When entering the U.S. market, Coherus had an opportunity to position Toripalimab as an affordable alternative to competitors like Merck’s Keytruda, which costs over $10,000 per dose.

Instead, Coherus explicitly stated that it would not engage in “heavily discounted pricing.” This decision underscores a common theme in the U.S. pharmaceutical industry: companies prioritize profit margins over patient access.

By pricing Toripalimab at nearly $9,000 per dose, Coherus ensures that the drug remains out of reach for many uninsured and underinsured Americans. Even those with insurance may face significant out-of-pocket costs, leading some patients to skip doses, ration medication, or forgo treatment altogether.

4. Regulatory Barriers Add to the Cost

Beyond corporate greed, regulatory inefficiencies in the U.S. also contribute to high drug prices. While China’s drug approval process has become more streamlined, the U.S. Food and Drug Administration (FDA) imposes rigorous and costly requirements that delay approvals and drive up costs.

For example:

• Clinical Trials: The cost of conducting FDA-mandated clinical trials in the U.S. is substantially higher than in China. According to a 2020 study published in JAMA, the median cost of clinical trials for new drugs in the U.S. is $19 million, significantly increasing the overall expense.
• Patent Exclusivity: U.S. patent laws allow drug companies to extend monopolies on medications by making minor modifications, preventing cheaper generic versions from entering the market.

While regulatory oversight is essential to ensure safety and efficacy, the current system disproportionately benefits large pharmaceutical corporations at the expense of patients.

The Brutal Truth: The U.S. System Enables Price Gouging

This is not about innovation costs or regulatory expenses—it’s about a broken system that prioritizes corporate profits over human lives. Americans continue to pay the highest drug prices in the world, while patients in China and other nations receive the same drugs at a fraction of the cost.

What Can Be Done?

• Government Price Negotiation: The U.S. should follow the example of other developed nations and allow Medicare and Medicaid to negotiate drug prices directly.
• Regulatory Reform: Streamlining FDA approval processes and reducing unnecessary bureaucratic hurdles could lower costs without compromising safety.
• Transparency in Pricing: Requiring pharmaceutical companies and PBMs to disclose actual manufacturing costs, R&D expenses, and pricing structures would expose price gouging.
• Encouraging Generic and Biosimilar Competition: Reforming patent laws to prevent companies from extending monopolies through minor modifications would allow cheaper alternatives to reach the market faster.
• Cutting Out Middlemen: Regulating PBMs and insurers to reduce the role of unnecessary intermediaries would bring down consumer costs.

Until the U.S. implements serious pharmaceutical pricing reforms, Americans will continue to be overcharged for life-saving medications—while patients in other countries pay a fraction of the cost.