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This is correct. The US pays for the world’s innovation, with few exceptions.

There are several mechanisms used by other countries, such as reference pricing and outright price controls. Many countries have a tender process for buying medicines. If the tender is not won, then the drug will simply be unavailable within the public health system, which could be 80%+ of health expenditures.

With the exception of outliers such as N. Korea, all of the so-called state run health systems are in fact two-tiered. The private systems in Canada and Europe, for example, have a quality of care (in terms of technology, wait times, outcomes, etc) on par with that of the US. However, in many countries it is doubtful that the public program will cover any expenses incurred in these private institutions.

In some countries, such as Mexico, drugs are paid for mostly out of pocket by the patient. As a result, there is good availability of innovative drugs, and prices are more rational in terms of response to competitive pressure than even in the US.