It’s perhaps analogous to how list prices for college tuition aren’t necessarily reflective of what people actually pay.

It’s a complex system and the price increases are used in part to negotiate with the intermediaries like PBMs.

Biologics are a special case also due to complexities in how they (and biosimilars) are regulated, manufactured, and exclusivity periods they are granted. They certainly are not a few cents a dose to make.

Not a satisfying answer, and apologies for that, but it’s difficult to traverse with anything approaching brevity.