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Here in Belgium the retail price is 170Euro (190USD) for Orgovyx but free for everyone (insurance is universal). I think these prices are negotiated at the European level so they have a bit of leverage.
The drug companies do need to recoup their investment though (including for any failed drugs along the way) so it looks like the US market is covering a lot of this cost and other markets get the lower rates (which is not fair I know).
On the other hand we don't have drugs available until later than the US: Orgovyx was only available in Nov 2023 in Belgium.
So if you need lifesaving drugs and can pay or have good insurance, the US model has positive points.
Forgot to mention that next year, the Medicare cap will be $2000. After that, you pay nothing.