Arguably "the same drug" will be the same everywhere, but if you're ordering online drugs from somewhere outside the FDA inspection regime, you don't know what your chances are that it's in fact actually "the same drug". Really, you don't know what you're getting.
That's still a possibility here, of course, but when a US producer commits fraud you'd better believe you'll have an army of lawyers beating down your door to help sue them into oblivion for it. Random Joe Bob's Discount Drug Shack operating in Singapore? Good luck.
Secondly, the FDA approval process itself. For better or for worse, having a complex medical trial and many layers of approval is probably better that not having it, in terms of protecting US consumers from unsafe foods and drugs. There's a fast-track process for promising drugs and devices to prevent dangerous conditions, and there registered experimental treatments, but all other things being equal, I'd prefer to know that some basic level of testing was done.
Drug IP process. People in other countries like to point out that they can purchase drugs for $20 that are charged higher processes here. You can thank us (the American Consumer) for that. Not everyone gets to be a marginal consumer.. and part of the reason we're paying full price for drugs is so that the market incentive allows those drugs to be developed in the first place. Without market incentive, you're only going to proceed in research as fast as centrally-planned authorities dictate you will. Or you're a charity, funded by donations.
None of those things directly deal with device IP, but to be honest cases like this (where someone is being an abject douchebag) are rare, and tend to get discovered, highlighted, and corrected through social pressure. (EMT's have been talking about the cost of EpiPens for years, and there were already initiatives under way to allow EMT's to inject Epi directly: http://thesouthern.com/news/local/govt-and-politics/new-state-law-will-allow-emts-to-inject-epinephrine/article_42dbddd9-a035-509b-b99a-7f720c7411b0.html
The measure, sponsored by state Sen. Chapin Rose, R-Mahomet, and signed into law by Gov. Bruce Rauner late last week, comes as the maker of the EpiPen is facing increased scrutiny from the federal government over dramatic price increases for the lifesaving drug. The cost of a two-dose package of EpiPens, made by pharmaceutical company Mylan, jumped from less than $100 nine years ago to more than $600 in May, The Associated Press reported Wednesday.
While the timing is a coincidence, Rose said recent attention from Congress has attracted the public eye to an issue that was first brought to him by a rural fire protection district he represents.
If there's a justifiable reason for a price hike, it'll become public as well. Often there is. E.g., a critical component has restricted availability.