Did some more research. People might find this interesting

Many older Americans are on cholesterol medication atorvastatin and very cheap. Mine comes from Kaiser Perm pharmacy and MFG = NOVADOZ. NOVADOZ is a NJ marketing company thats a wing of MSN (google msnlabs). MSN is an Indian company. So many people are already drinking cheap meds likely from India.

Bristol Myer Squibb's (BMS) world wide locations shows manufacturing in China as well as western leading nations like US and various EU countries. These western manufacturing locations are often biologics meaning drugs grown by biology. These are more advanced and likely trickier to produce. So it is quite natural formulated drugs shift towards lower cost countries (India seems to be leader) google CPHI events (pharma conference) 10x in next year are 2x China, 1x Thailand, 1x India, 1x Saudi Arabia 2x EU, 1x Korea, 1x Japan, 1x US.

For drugs like Eliquis and Entresto (my mother use this as well for AFib and is pricy) It is likely US drug companies always aim at 15-20 of high profits from newer drug discoveries with improvements. Lock in the patents and keep strict distribution in wealthy countries to lock in higher profit. Eliquis generics was successfully blocked by BMS+Pfizer (coinventers) in 2021 in US courts. Eliquis is the #1 drug expense on Medicare and represent $12B out of $45B 2023 revenue for BMS.

So the goal for US drug companies is to pitch medical community to prescribe latest patent enforced drug (and newer drugs are usually better just maybe not as much as they pitch. There are other blood thinner alternatives to Eliquis which just gradually falls out of favor amongst the US medical establishment) Lobby hard in congress and hire lawyers to defend the patents. And generally scare the living day lights out of consumers to buying overseas where the drug was likely made anyways.

So its all grey market for the cheaper sources from overseas. And gov+industry+medical community are all making $$$ from mostly elderly US consumers paying for leading drug development and providing no info on cheap oversea solution naturally generates consumer distrusts.

Not suggesting we all drink meds from India Turkey and buy from online Canadian Pharmacies. But likely most of the cheap drugs no longer protected by patents are already coming from there. I read Canadian online pharmacies are usually just an online presence and just have distribution agreements with oversea pharmacies to drop ship drugs directly from say India and Maruitius (little island nation in the middle of Indian Ocean) Cheaper Eliquis are typically Product of Turkey made in Puerto Rico labled as Pfizer (contract manufactured by BMS) and shipped via Maruitius. Maruitius must offer laws that allow grey market side step entry into US.

So I wonder if Eliquis my mother is using is basically same as made in Puerto Rico by BMS shipped from Maruitius. Seems likely but gov+pharma+medical industry in US is never going to confirm or provide any kind of clarity. Rather, their aim is to create distrust to lock-in their profits. Even pharmacies gets a cut and of course elected gov officials through lobbying.