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Why Brand-Name Cant Match Price Structural Barriers: Public Company Obligations: Must maximize shareholder return Quarterly earnings pressure Executive compensation tied to profits Cant dramatically reduce price without stock impact Sunk Costs: Billions invested in development Need to recoup investment Justify to shareholders and board Complex Distribution System: PBMs demand rebates Wholesalers take cut Pharmacy margins Cant easily change system Market Dynamics: Limited competition (patent protection) Can charge premium prices Demand exceeds supply No pressure to reduce Eli Lilly unlikely to reduce tirzepatide prices significantly while patents protected