The current system is 90% broken. Or maybe it's 50% broken, but regardless of what number you want to put on it the reality is that Big Pharma is failing to adequately look after the citizen payers that fund it.
It's worth reading my article from Liver International for an overview
onlinelibrary.wiley.com/doi/10.1111/liv.13157/full which covers off on a lot of the arguments. Like the 19 x disparity between spending on marketing (25% of gross revenues) and R&D (1.3% of gross revenues)
Profit is a great motivator but as things stand we have a massive lack of innovation because there is more profit to be made at lower risk by minimal modification "me to" drugs and simply ever-greening existing technology through trivial chemical modification. TDF and TAF for HIV are a perfect example of "non innovation" being granted a new patent. The fact that Gilead has pushed the more poisonous TDF onto patients despite developing the lest toxic TAF form of Tenofovir at the same time should be cause for global outrage. It isn't, but it should be.
For those that don't know Tenofovir is an HIV/Hep B treatment. The active bit is Tenofovir. The salt bit is either disoproxil fumarate (TDF) or alafenamide (TAF). TDF causes long term side effects. TAF can be taken at a lower dose and causes less. Both were invented at the same time (no doubt along with many other salts of Tenofovir) but TAF was shelved so it could be rolled out as "New improved Tenofovir" but more importantly with a "new patent". This is bullshit, scamming and ripping off the insurers and taxpayers. It's better than "New Coke" but at least they did not get to patent that. Pushing forward something more toxic (when you have something less toxic) should be a "Do not pass go, go directly to jail" offence. If not that a "Please explain" congressional hearing. And failing that a "Go and stand in the naughty corner".
It took a long time for things to get this broken, and it will take a long time to modify things to favour new innovation, however it is something that has to happen.
The simplest way for "fix" drug pricing is to apply market forces.
Parallel imports from allied markets ie From Canada -> USA would halve US drug prices more or less overnight. I expect this is what will transpire as it is the path of least resistance.