Americans pay the highest prices in the world for lifesaving medicines — roughly triple what people in the world's other big economies pay for the same name-brand, on-patent drugs. The cost of producing a medicine generally doesn't vary much — so it stands to reason that the US's big pharmaceutical companies should therefore earn far more in the US than they earn elsewhere. Simple math.
It is undeniably allowed by the tax law, but it is still an outrage. Americans are not only paying through the nose for their prescriptions but also receiving none of the benefits from having a robust"American" pharmaceutical industry. The tax revenues from US sales are being paid abroad, rather than being reinvested in new research at the National Institutes of Health. Pharmaceutical-manufacturing jobs are being created abroad, rather than at home.
On paper, America's corporate-tax rate is 21%, but the country's largest and most profitable pharmaceutical companies don't pay anything close to that. The effective tax rate for most of the big pharmaceutical companies on the profits they keep in the US is much closer to 10%. But since most of their profits are shifted overseas, the eight largest US pharma companies end up paying only about 3% of their global profit to the US Treasury.
But instead of solving the problem, the 2017 Trump corporate-tax reform made it worse. The law imposed a special 10.5% tax rate on profits made outside the US. This would seem to solve the issue — money parked in other countries was still subject to collection from the Treasury.