https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi...
If you had said Luxembourg, Switzerland & Norway I would have agreed with you. That's only about 14 million people though.
This seems to ignore the obvious discrepancies between income inequality in the US vs. Sweden & Germany. Our Gini coefficient is higher than both, as is our poverty rate.
Our high GDP masks the fact that our world's-highest drug prices have a disproportionately negative effect on our poorest citizens.
I never said that.
My point is simply that pointing at nominal GDP paints an inaccurate picture. The US is a complex and extremely heterogenous market, and using a single economic measure to justify nationwide pricing is a bit like taking the temperature average of the man whose head is in the oven and feet in the freezer.
It's feasible to imagine a world in which drug companies apply the same adjusted pricing to poorer segments of the US market as they do foreign customers. They don't in practice, allegedly, because of Medicaid regulations enforcing a lowest-in-country price [1]. Regardless of whether that particular explanation holds water, the idea of price discrimination within the highly unequal US market is reasonable.
[1] https://object.cato.org/sites/cato.org/files/serials/files/r...
I can see how that might be tricky to get to politically though.
https://www.medicaid.gov/medicaid/financing-and-reimbursemen...
https://aspe.hhs.gov/basic-report/fy2017-federal-medical-ass...
Critical access hospitals and rural health clinics probably overlap too, where Medicare pays out to smaller qualifying facilities using a different formula.