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Monopolies or oligopolies exist where moats prevent new competitors. It’s easy to find capital, labor, and regulatory approval for a new restaurant, so we see tons of competition and low margins. Hollywood sees big margins because blockbusters require huge capital outlays other film markets can’t compete with. A hospital might have huge margins because competitors are barred by law from entering the marketplace. High-end microchip manufacturing is so difficult that nearly all skilled engineers in the field are concentrated in a few firms, so no one else can make products of a similar quality no matter the capital outlay.
Drug manufacturing is a combo of all three. You need a ton of capital, regulatory approval from the FDA, and some skilled industrial chemists. It’s somehow legal to ‘pay for delay’, where company A pays company B to not make their drug, but this only works when B is the only competitor with sufficient industrial capacity to compete. Ibuprophen is old, easy to make, with huge demand; weak moat, so the price is great. But long-acting insulin analogues like glargine or degludec are new, complex biologics targeting the small DMI market; it’s too expensive to compete so great margins, high price. The problem is similar to adverse selection; a small number will buy at any price, so either sick people get extorted, it’s subsidized by the public pocketbook, or new drugs are underprovisioned. Pick your poison.
It's even called a CON.
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