Despite promises of affordability, MFN's price reductions primarily lower costs for the US government. For the majority of patients on fixed copay plans, their out-of-pocket expenses for a drug will not decrease even if the government negotiates a lower price. Only patients on coinsurance plans would see a direct reduction.
Related Insights
Initial panic over the MFN drug pricing scheme was based on pegging U.S. prices to the lowest in the industrialized world. The actual proposal is far less drastic, targeting the second-lowest price among a small cohort of high-income nations (G7 plus Denmark and Switzerland), a significantly less onerous benchmark.
The administration is leveraging the U.S.'s market power to demand "most favored nation" pricing from pharmaceutical companies. This forces them to offer drugs at the lowest price available in any other developed nation, slashing costs for American consumers.
While MFN may encourage value-based deals globally, it creates an implementation hurdle. MFN policies reference a simple price per unit (SKU), but value-based agreements are outcome-dependent. This makes calculating and reporting a single, compliant "net price" to the US government incredibly complex and operationally burdensome.
While MFN pricing is seen as a major threat, it could have an unexpected positive effect. It would force companies launching new drugs to establish a GDP-adjusted global price from the start, ending the current system where the U.S. effectively subsidizes lower prices elsewhere.
By voluntarily agreeing to a watered-down version of a 'most favored nation' pricing system, pharmaceutical companies have inadvertently set a precedent. This makes it harder for them to argue against more stringent, codified pricing regulations from future administrations, as they can no longer claim it's a 'red line' they cannot cross.
A centrist solution to high drug prices involves combining ideas from both political aisles. Oliver Libby suggests allowing Medicare to negotiate prices (a left-leaning idea) while also extending patent life for drug companies (a right-leaning idea), thus lowering costs without killing the incentive for innovation.
By negotiating the price of weight-loss drugs from $1,200 down to ~$200, the administration expects a net positive ROI for the government within two years. The savings from preventing obesity-related chronic illnesses will outweigh the drug costs.
The Most Favored Nation (MFN) policy was strategically designed to be disruptive. The aim was less about implementing a specific pricing framework and more about forcing the pharmaceutical industry to change its behavior, re-evaluate global strategies, and engage in new types of negotiations, which has already proven effective.
Agreements often labeled "MFN deals" are more accurately tariff-avoidance arrangements. In these deals, pharmaceutical companies commit to significant investment in US manufacturing in exchange for price parity, suggesting a broader policy goal beyond just drug price reduction and focused on boosting the domestic economy.
New "voluntary" CMS programs, like BALANCE for obesity drugs, are creating a framework for Most Favored Nation (MFN) style pricing in the US. They allow manufacturers to trade lower, internationally-referenced prices for higher volumes, fundamentally altering the US pricing landscape from the inside out.
