I have spent most of my career fighting and dealing with budget reductions in R&D - many of them totally arbitrary and just belt-tightening (i.e. not because of a major trial failure, shift in priority, etc.). I've more or less come to terms with it. The fact of the matter is R&D spends money, and can only offer the promise of profit. R&D tries to build a pipeline, but it is more attractive, often, to cut internal spend and look for BD/M&A externally for a mature 'asset' rather than develop it yourself. That's with big Pharma. Having spent time in biotech/startups, we're always trying to sell ourselves to big Pharma because they have no new ideas and are plodding behemoths.
I'm on the research side, but will occasionally go to the big clinical conferences (like the American Society for Clinical Oncology). That's the big one in my field, at least for the corporate side as well as late breaking clinical trial data. But to rent a booth is exorbitant (many tens of thousands and up), and if you want to serve something as simple as coffee, add in another few tens of thousands. Now look at the big pharma booths that occupy hundreds of plush square feet, modeled after a trendy cabaret in Ibiza, where you can go drive some VR car through a maize of cancer cells just to get a little plushy and post it on Twitter. A patient's right advocate would have a stroke (no pun intended). It's a funny, and sometimes perverse, business - like many, I suppose when you start talking about big money.
And yes, I know I sound like this guy now:
The reality is those big drugs, and even the legacy drugs, keep the lights on. How much is fair pricing in the US market, relative to the rest of the world, is a totally relevant conversation for which there isn't a particularly easy answer.