Ok, too much to go into here, but I can point you in the right direction if you want to look it up. So the main thing is U.S. pharmaceutical companies get a lot of the base research of new drugs from universities, which have large PhD level research power in the form of grad students and researchers who can do most of the ground work that usually turns out to be meaningless. Sometimes companies can pay universities for both research and the patents on promising drugs discovered in the course of research. Since universities aren't set up to produce drugs, they get the $$$ and prestige of being involved. Companies get the rest.
Where people get in a tizzy, is the fact that as a whole, the industry spends over $100 B/yr. on R&D, most of which goes to experimental or unapproved drugs that don't go anywhere. Then there's the cost of actually producing these chemicals in a safe manner. The deal allows companies to cover these costs by charging high prices, and patents that last several years giving a company the sole rights to produce a drug. That's where most of the friction comes in. Profits.
Nobody can predict if a drug or treatment will be successful until it has gone through full FDA approval lasting years. There isn't really a more reliable system other than testing drugs on the public and watching people die etc.
I forgot to add the main point. The U.S. companies have been selling our drugs at around cost to foreign countries for years... You may remember the stories of elderly people taking trips to Canada to get their meds. We are subsidizing cheap medicine for the rest of the world.
My German cousin waited years to get orthodontic jaw surgery that would of taken months in the U.S.
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