I assumed it was by volume\weight. If it was by dollars, we might slide toward parity a bit.I wonder if the metric is by weight/dose or by dollar value. Quite often we pay high multiples of the price given by the same company to other countries for the same drug because they have national health care systems that have bargaining power in such negotiations. That would skew any measurement by dollars spent
The answer to that problem is to shut down their ability to recoup lost profits by just charging US customers more. Although some anti-gouging limitation for pricing, perhaps restricting US pricing to some small multiple of the lowest price offered else where, which failure to comply with would trigger the ability to use other countries as middle men as with the current grey market with Canada