With certain niche medications like trientine it used to be a small manufacturer, the scale of a man with a garage, who had the FDA registration and sold the stuff for a price that allowed him to make a living. That worked fine, until investment banking got there, and raised the price to whatever the market would bear.

Those days are gone, like the old web. Not sure, if the DIY movement can put enough pressure on the drug cartel to drop prices. Then again, university librarians had been complaining about Elsevier since the 1990's, but nothing got done until Sci-Hub appeared. That's the hammer argument against Crito.