the fix here is create a system where patents can be taken away for excessive profits. if your manufacturing cost is $10 a pack and you sell it for $500 after you already paid off development you deserve to lose it.

That is a lot more pie in the sky than tightening origional patent review. You would have to throw out 200 years of patent law and face several constitutional challenges.

A more moderate response would be for government programs like medicare and medicaid to simply refuse buy products with such a high markup. This is called purchasing controls and practiced by many European countries.