It shouldnt be limited to companies within the country. Any foreign company can be a market disruptor here. Assuming the drug approval admin isnt working alongside the 'cartel'.

And only in the very particular scenario of a national-only cartel which has not successfully roped in other international pharma companies.

And then there's medical tourism, for the people who prefer to shop at one of the other 'cartels'

And as long as those cartels aren't powerful enough to buy the government into submission.