Why charge $138 when your customers will pay $1,145 and keep coming back?

you need someone willing shop and pick the cheaper options for competition to bring down prices. You also need someone willing to say "that's too expensive, I wont buy it" and walk away. Same is true for the inhalers. If someone will pay $100 before switching to the generic, that is what they get charged. In Canada, the state is only willing to pay $10, so that is the price. This is the demand side of the problem.

There is also a supply problem, where the state provides medical company monopolies through "certification of need". It is basically illegal to open an MRI clinic that would compete with an existing one in many jurisdictions.

https://radiologybusiness.com/topics/medical-imaging/magneti...