It costs tens of millions of dollars in large part because US healthcare is so expensive. The actual handing out of drugs is fairly low effort, it's everything else that makes trials so expensive.
It costs 10s of millions of dollars because that is how you prove a drug is safe. That isn't unique to the US. If you want to launch a new drug in the EU, it's not going to cost you any less.
the number of FDA-regulated investigators running trials abroad has increased by 15 percent each year, while the number of U.S.-based investigators declined 5.5 percent annually.
Several forces are pushing trials elsewhere, the researchers noted: cost (a trial at a top medical center in India may cost less than one-tenth per patient what it would cost at a second-tier U.S. center); faster approval times; and less red tape. http://health.usnews.com/health-news/managing-your-healthcar...