My meaning was that there is no other therapeutic agent available for prevention of post-ERCP pancreatitis. But you're quite right, there must be another reason.

If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play.

To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.