When a Drug Launch Moves, the Business Changes Too

What Roche's European plans mean for pharmaceutical companies and investors

By Ron Lanton

For pharmaceutical companies, getting a new drug approved is only part of the job. Deciding when and where to introduce it can be just as important.

Those decisions are becoming more complicated as the United States pushes drugmakers to narrow the difference between American and foreign drug prices.

In an October 26 Endpoints News article, Maggie Fick reported that Roche has changed its anticipated European regulatory timeline for giredestrant, an investigational breast cancer treatment.

Roche previously expected to seek European approval in 2026. It now plans to begin discussions with European regulators in 2027, without providing a new filing date.

Roche says it wants more mature clinical evidence to support its application and improve its prospects for sustainable reimbursement. There is no public evidence establishing that U.S. most-favored-nation (MFN) pricing policy caused the change.

Still, the development raises a question worth examining.

Why launch timing matters

Drugmakers have traditionally introduced new medicines in the United States first, where the commercial opportunities have generally been greater.

Europe presents a different calculation. Companies must consider regulatory requirements, health technology assessments and pricing negotiations that vary across countries.

Germany's AMNOG system and France's pharmaceutical pricing framework are examples of those differences.

Now add the possibility that lower prices negotiated overseas could influence what a company receives in the United States.

That could change how executives evaluate the timing of European launches.

For patients, the consequences can be substantial. A delayed launch may mean waiting longer for access to a treatment.

The financial implications

For biotechnology companies, regulatory approval and commercial access are not the same thing.

A company may receive approval but still face months of reimbursement negotiations and additional evidence requirements before reaching a broad patient population.

These decisions affect revenue forecasts, manufacturing, distribution agreements and financing needs.

They can also influence licensing and acquisition negotiations. Investors and potential buyers need to understand not only whether a product is likely to receive approval, but when it can begin generating revenue in different markets.

A delayed filing does not necessarily translate into an equivalent delay in sales. Each market has its own regulatory and reimbursement timelines.

What executives should be watching

According to the Endpoints News analysis, 44 new medicines entered European regulatory review during the first nine months of 2026, compared with 51 during the same period in 2025.

That decline deserves attention, but it does not establish that U.S. pricing policy caused it. Europe faced challenges attracting innovative medicines before MFN entered the discussion.

The concern is that MFN could make an already complicated situation more difficult.

For pharmaceutical executives, regulatory planning, pricing and reimbursement need to be considered together.

For investors, the questions extend beyond FDA approval dates. International launch schedules, reimbursement assumptions and the timing of expected revenue all deserve attention.

A promising medicine is only part of the investment case. Getting it to patients, and understanding when that can happen, matters just as much.

Ron Lanton is Senior Partner and Global Strategist at Lanton, Lanton & Sosa Law PLLC.

Related reporting: Maggie Fick, “Roche's changing plans show how MFN is complicating European drug launches,” Endpoints News, October 26, 2026.

Could Switzerland Be Next? U.S. Drug Pricing Pressure Expands Beyond Germany

The United States is examining German pharmaceutical pricing practices under a trade investigation that could have consequences well beyond Germany. Switzerland, France, and other countries may face similar scrutiny.

For pharmaceutical companies, this is becoming a question of where to launch new medicines, how to negotiate prices, and whether decisions made in Europe could affect revenue in the United States.

I recently discussed these developments with Francesca Bruce at Pink Sheet, including which countries could face additional scrutiny and how governments might respond.

Why Switzerland Could Be Next

The U.S. Trade Representative opened a Section 301 investigation into German pharmaceutical pricing practices in June. The investigation includes Germany's AMNOG benefit assessments, mandatory rebates, and drug price freeze.

The concern is that these policies may place an unfair burden on American commerce.

Switzerland is another country worth watching.

In June, members of Congress raised concerns about Swiss proposals to reduce pharmaceutical spending. René Buholzer, CEO of the Swiss pharmaceutical industry association Interpharma, also warned that Switzerland could face scrutiny similar to Germany's.

Switzerland faces an additional complication. Unlike Germany and France, it is not an EU member and would need to manage any U.S. trade dispute through its own negotiations.

That does not leave Switzerland without options. It does mean the Swiss government and pharmaceutical industry may need to respond independently.

France Has Taken a Different Approach

France recently reached an agreement between its pharmaceutical pricing authority, CEPS, and the industry association Leem.

The agreement seeks to make pharmaceutical pricing more predictable, better recognize innovative medicines, and allow temporary higher prices in certain circumstances.

Those changes may help France respond to American concerns about European drug pricing.

They do not necessarily settle the matter.

The United States could still examine France's broader pricing framework, including pharmaceutical taxes, rebates, reimbursement delays, and patient access. Proposed increases in pharmaceutical taxes for 2027 could complicate France's efforts.

Could Germany Reach a Deal With Washington?

Germany may ultimately choose to negotiate rather than risk additional tariffs on pharmaceutical exports to the United States.

The UK-U.S. pharmaceutical trade agreement offers one possible model. Under that agreement, the UK committed to increasing pharmaceutical spending over time and improving market conditions for manufacturers.

Germany could consider a similar arrangement, particularly if the government concludes that a negotiated solution offers greater certainty for its pharmaceutical industry.

That outcome is far from guaranteed. Germany would still need to balance domestic healthcare spending against pressure from Washington.

What Pharmaceutical Companies Should Watch

Companies developing international launch and pricing strategies should pay attention to three questions.

First, will additional countries become targets of U.S. trade investigations?

Second, will European governments change pharmaceutical pricing or reimbursement policies to reduce the likelihood of trade disputes?

Third, how might those changes affect the timing of product launches, licensing agreements, and expected U.S. revenue?

The answers will matter to established pharmaceutical manufacturers and smaller biotechnology companies preparing for commercialization.

Pricing decisions made in one country no longer have consequences confined to that market. Companies must consider how those decisions could affect their business elsewhere.

The German investigation is still developing. Switzerland and France have not been established as the subjects of equivalent new investigations. For now, manufacturers should distinguish policy proposals and political warnings from formal government action.

Related reporting: Ron Lanton discussed these issues with Francesca Bruce in her October 21, 2026 Pink Sheet article, “USTR Investigation Into German Drug Pricing: Who Could Be Next?”.

Ron Lanton is Senior Partner and Global Strategist at Lanton, Lanton & Sosa Law PLLC, advising healthcare and life sciences organizations on regulatory, pharmaceutical policy, and international business matters.

This article is provided for general information and is not legal advice.

340B Rebate Pilot Returns to Court: What Covered Entities and Manufacturers Should Watch

The 340B Rebate Model Pilot Program is back in court before its planned January 1, 2027 launch.

The American Hospital Association, Maine Hospital Association and four safety-net hospitals filed suit in the U.S. District Court for the District of Maine on October 9, 2026. They are asking the court to block the revised pilot and issue a temporary restraining order preventing it from taking effect while the case proceeds. www.beckershospitalreview.com

The hospitals argue that HHS and HRSA did not adequately account for the program’s financial and administrative burden. They say the revised model could increase drug-purchasing costs, strain cash flow and divert resources from patient care.

This is the second lawsuit over the rebate model. The first version was scheduled to begin on January 1, 2026. A Maine district court and the appeals court blocked it after raising concerns about the speed of the rollout and the agency’s treatment of public feedback. HRSA later withdrew that version and developed a revised program. www.beckershospitalreview.com

What the revised pilot changes

Under the current 340B model, covered entities generally purchase eligible drugs at or below the 340B ceiling price.

The revised pilot would use a different process for a limited group of drugs. Covered entities would purchase the drugs through their existing distribution arrangements and later seek a rebate equal to the difference between the wholesale acquisition cost and the 340B ceiling price.

HRSA says the pilot will improve transaction-level visibility, allow claims to be checked before rebates are paid and reduce the risk of duplicate discounts. HRSA has approved plans for 10 manufacturers covering 21 drugs. The plans are scheduled to begin January 1, 2027. Drugs outside the approved plans remain under the upfront discount model. www.hrsa.gov

The approved manufacturers include AbbVie, Amgen, Astellas, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, GSK, Merck, Pfizer and Teva. HRSA has posted the specific drugs and plan terms on its program page.

The cost dispute

The hospital plaintiffs say the government underestimated the cost of the new system.

Hospital analyses estimate more than $1 billion in annual administrative costs. HRSA has estimated approximately $537 million across covered entities. The difference involves startup expenses, rebate reconciliation, cash-flow effects, technology systems and ongoing administrative work. www.beckershospitalreview.com

The AHA also says the revised pilot is roughly twice the size of the original proposal and that HHS moved ahead after receiving more than 2,400 comments about the program’s financial and operational effects.

Those claims remain allegations unless the court accepts them.

What covered entities should review

The revised pilot creates specific deadlines.

Covered entities generally must submit claims data within 45 calendar days after dispensing a drug. Manufacturers must pay or deny a completed submission within 10 calendar days. A denial must include supporting documentation. If a submission is incomplete, the 10-day period starts again after the missing information is submitted. www.hrsa.gov

HRSA also says covered entities should use their existing 340B wholesaler accounts for pilot drugs rather than creating separate ordering systems.

Covered entities should review:

• which purchases are covered by an approved plan;

• who collects and submits the required data;

• who corrects incomplete submissions;

• how rebate timing affects cash flow;

• how claims, dispensing and eligibility records will be reconciled.

Contract pharmacies will also need to understand how covered-entity purchasing, dispensing records, claims data and rebate payments fit together. The pilot does not remove existing recordkeeping requirements involving dispensing, eligibility, diversion or duplicate discounts.

What manufacturers should review

Manufacturers must follow their HRSA-approved plans and prepare for questions about data requirements, denials, payment timing and system performance.

HRSA says changes to an approved plan require additional agency review and approval. Manufacturers cannot change the plan without following that process. www.hrsa.gov

Manufacturers should also review their wholesaler arrangements, claims systems, compliance procedures and communications with covered entities.

What happens next

The court could allow the pilot to proceed, require additional procedures or delay implementation.

For now, covered entities and manufacturers should plan for the January 1 date while monitoring the litigation. The case could affect the future use of rebate models in the 340B program and clarify how HRSA’s oversight authority applies to a system that changes when and how covered entities receive the benefit of the discount.

How Lanton, Lanton & Sosa Law can help

Lanton, Lanton & Sosa Law PLLC works with 340B covered entities, pharmacies and manufacturers on the contract and compliance questions that determine how drugs are purchased, reimbursed and delivered to patients. We help clients understand changing 340B requirements, assess the effect on their operations and contracts, and prepare for disputes or implementation issues.

The HRSA 340B Rebate Model Pilot Program page includes the approved manufacturer plans, guidance and frequently asked questions. The Federal Register notices are also available through HRSA.

What HRSA’s Revised 340B Rebate Pilot Means for Contract Pharmacies, Health Systems and FQHCs

On October 1, HRSA disclosed that ten manufacturers had received approval to participate in the revised 340B Rebate Model Pilot Program. The approved plans cover 21 drugs, and the program is scheduled to begin January 1, 2027.

The HRSA pilot page now lists the participating manufacturers, covered drugs, technology platforms and implementation requirements. The pilot will use rebates instead of upfront discounts for a limited group of drugs connected to the Medicare Drug Price Negotiation Program.

That change matters to covered entities, health systems, federally qualified health centers and contract pharmacies because it affects purchasing, claims data, reimbursement timing and compliance responsibilities.

This is a second attempt

The revised pilot follows an earlier effort that was scheduled to begin January 1, 2026.

Covered-entity stakeholders, including the American Hospital Association, challenged the original program under the Administrative Procedure Act. The U.S. District Court for the District of Maine issued a nationwide preliminary injunction on December 29, 2025. The First Circuit declined to stay that order, HHS withdrew the original pilot, and the Maine court later vacated and remanded the original notices and manufacturer approvals.

HRSA’s revised program is therefore a new and contested approach, not a simple restart. On October 1, the AHA said it was considering all available options to stop the revised pilot. That statement does not establish that a new lawsuit has been filed, though further litigation and congressional action remain possible.

The D.C. Circuit’s decision in Novartis Pharmaceuticals Corp. v. Kennedy confirms that Section 340B permits rebate models and that manufacturers may not implement them without HHS approval. The court did not decide that every possible rebate model would comply with the statute.

The pilot is narrower than the program as a whole

The pilot does not apply to every 340B drug.

HRSA limits it to the NDC-11s of drugs appearing on the CMS Medicare Drug Price Negotiation Selected Drug Lists for initial price applicability years 2026 and 2027, and only during the applicable price periods.

HRSA estimated that the eligible universe represented less than 5.5% of total 340B sales. The final approved plans cover 21 drugs, so the share actually affected by the pilot may be smaller than the initial estimate. The remaining 94.5% of 340B sales is expected to remain under the upfront-discount model in 2027.

The broader $100 billion figure describes total 340B purchases, not the size of the rebate pilot. Program-wide specialty-pharmacy and covered-entity statistics should not be presented as though they describe the pilot’s reach.

What changes for covered entities

For affected drugs, covered entities may need to purchase through existing distribution channels at the wholesale acquisition cost and then submit claims data to receive the 340B rebate.

The approved plans must provide:

• At least 90 calendar days’ notice before implementation.

• At least 45 calendar days from the date of dispense to submit required data.

• Payment of the rebate, or a documented denial, within 10 calendar days after a completed submission.

• A 15-calendar-day transition grace period for up to two unreplenished accumulated packages dispensed before the effective date, provided the rebate request is still submitted within the 45-day period.

The 90-day notice period should be underway now for plans intended to take effect January 1, 2027. Covered entities should confirm when each manufacturer delivered its notice and whether the notice explains the required registration and data-submission process.

The approved plans also require manufacturers to identify the technology platform used for submissions, pay the platform’s costs, provide claim-status information and document the reasons for denied rebates.

The ten-day payment clock begins only after a completed submission. If a submission is returned as incomplete, the clock restarts when the missing information is provided. That makes the process for correcting incomplete claims an important operational issue.

The cash-flow issue needs a balanced assessment

The rebate model may require some entities to order selected drugs at WAC rather than receiving the 340B discount at the point of purchase.

HRSA expects the cash-flow effect to be limited because, in most cases, payment to wholesalers should occur after the manufacturer rebate is received. The pilot also uses unit-level rebate processing and includes transition accommodations intended to reduce inventory disruption.

That expectation may not hold equally for every entity. Cash-flow exposure will depend on wholesaler payment terms, claim-submission speed, incomplete data, denials, credit arrangements and the entity’s ability to reconcile claims promptly.

Covered entities should model the timing by drug, manufacturer, dispensing channel and contract-pharmacy arrangement rather than assume that the financial effect will be either insignificant or severe.

What executives should do now

Health systems, FQHCs and contract pharmacies should:

1. Identify the affected NDC-11s and determine which dispensing channels are involved.

2. Assign responsibility for claim submission, reconciliation, corrections and denial appeals.

3. Confirm that pharmacy, wholesaler, TPA and 340B software systems can produce the required data.

4. Test the 45-day submission window and ten-day payment timetable.

5. Review wholesaler credit terms and model exposure during delayed, incomplete or denied claims.

6. Confirm whether the manufacturer’s 90-day notice has been delivered and whether platform registration is required.

7. Track the 15-day transition rule for unreplenished inventory.

8. Document how the new process affects patient access, inventory and reimbursement.

How Lanton, Lanton & Sosa Law PLLC can help

Lanton, Lanton & Sosa Law PLLC advises healthcare organizations, pharmacies and life-sciences companies on 340B, reimbursement, regulatory compliance and government affairs.

For this pilot, that work may include reviewing manufacturer and contract-pharmacy arrangements, assigning legal and operational responsibilities, evaluating claims and data requirements, assessing denial and dispute procedures, modeling reimbursement exposure and preparing for agency or manufacturer inquiries.

The revised pilot is limited in scope, yet it introduces a new payment and data process into a program that serves thousands of covered entities. The entities that prepare early will be better positioned to identify errors, protect reimbursement and maintain access for patients.

Sources

• HRSA 340B Rebate Model Pilot Program

• Federal Register notice, 91 FR 48883

• Novartis Pharmaceuticals Corp. v. Kennedy, D.C. Circuit

• CMS Medicare Drug Price Negotiation Program

340B Rebates: Who Bears the Cost of Changing How the Program Works?

Why the 340B Program Matters

Congress established the 340B Drug Pricing Program in 1992 to help eligible healthcare organizations stretch scarce resources and serve patients. Under the program, manufacturers participating in Medicaid and Medicare Part B agree to provide qualifying outpatient drugs at or below a statutory ceiling price to eligible hospitals, health centers and other providers known as covered entities. The program has generally delivered that price through an upfront purchasing discount. [1]

That purchasing arrangement is now embedded in many organizations’ pharmacy operations. Covered entities use 340B savings in different ways, which can include supporting medication access, specialty services and care for patients who may face barriers to treatment. The program is also operationally complex: hospitals and clinics may use in-house or contract pharmacies, wholesalers, inventory replenishment systems and third-party administrators to determine which transactions qualify.

The 340B statute prohibits diversion of discounted drugs to ineligible patients and duplicate discounts involving Medicaid rebates. Determining which transactions qualify and identifying overlapping price concessions have become persistent administrative questions as the program and pharmaceutical distribution arrangements have grown. [1]

HRSA’s revised rebate pilot is designed to test whether a rebate-based approach addresses these administrative questions more effectively than the existing upfront-discount model. It applies to a limited set of drugs, rather than changing 340B purchasing across the program. [1, pp. 48,894–48,896]

Why Manufacturers Are Interested in a Rebate Model

Manufacturers have argued that an upfront discount can make it difficult to verify the specific transaction that ultimately qualifies for 340B pricing. They have sought greater visibility into claims data to identify duplicate discounts, evaluate eligibility and reconcile overlapping requirements across federal drug-pricing programs. For selected Medicare-negotiated drugs, the pilot also addresses potential overlap between 340B discounts and Medicare Maximum Fair Price (MFP) discounts; these price concessions are not cumulative. [1, pp. 48,884–48,886]

Supporters of rebate-based arrangements contend that linking payment to a validated dispensing or administration record could improve claims-level transparency and reduce the need to identify problems only through retrospective audits. They also argue that covered entities and their administrators already collect much of the information that would be used for reporting. [1]

Those arguments do not resolve every implementation issue. More transaction data raises questions about the information manufacturers may receive, permitted uses of that information, privacy, platform governance and the cost of producing and verifying claims. Whether the anticipated benefits materialize is part of what the pilot is designed to examine.

What the Revised Pilot Would Actually Change

In July 2026, the Health Resources and Services Administration announced a revised, voluntary pathway for qualifying manufacturers to provide 340B pricing through rebates instead of upfront discounts. The pilot is limited to selected drugs in the Medicare Drug Price Negotiation Program with initial price applicability years 2026 and 2027, during their applicable pricing periods. HRSA estimates that the included products represent less than 5.5% of total 340B sales, based on 2025 data. The rest of the program would continue using upfront discounts in 2027. [1, pp. 48,893–48,894; 2]

For an approved participating product, the covered entity would order through existing distribution channels at wholesale acquisition cost (WAC). Following an eligible dispense or administration, it would submit specified transaction information. The rebate would equal WAC minus the applicable 340B ceiling price on the day of dispense and would be paid at the unit level. This means the financial benefit arrives through a separate transaction rather than being reflected in the initial acquisition price. [1]

The revised framework includes several operational safeguards. Manufacturers must fund the required submission platforms and provide technical assistance. Their approved plans must allow at least 90 calendar days’ notice before implementation, and covered entities must have at least 45 calendar days after dispensing to submit data, with specified allowances for exceptions. Manufacturers must pay the rebate or issue a documented denial within ten calendar days after receiving a complete submission. An incomplete submission can restart that payment clock when the missing information is supplied. [1]

The pilot is scheduled to begin January 1, 2027, for manufacturers whose rebate plans receive HHS approval. It does not change purchasing for products outside its limited scope. [1]

Why Hospitals Are Concerned

Hospitals and health systems have raised concerns about the effect of moving from a known upfront acquisition discount to a later rebate. One issue is liquidity: an organization may need to purchase a high-cost drug at WAC, hold it in inventory, dispense or administer it, submit transaction information and wait for a validated rebate. Even a ten-day payment requirement begins after a complete submission, not necessarily on the purchase date. [1]

Covered entities have also pointed to potential administrative costs, including staff training, system changes, reconciliation, disputed transactions and changes to wholesaler credit arrangements. Their concern is not limited to whether a rebate ultimately arrives. For some hospitals, uncertainty or new financing costs could affect resources used to maintain services, including medication access and other programs serving vulnerable patients. Those effects would differ by facility and cannot be inferred from a uniform estimate. [1]

HRSA takes a different view of the likely financial impact. It expects the ten-day deadline, unit-level rebates and existing wholesaler payment windows to allow many organizations to receive rebates before their wholesaler invoices become payable. The agency also expects existing pharmacy systems and third-party administrators to absorb much of the additional work, although it acknowledges that some covered entities may need new resources. [1]

The two positions turn in part on actual purchasing arrangements. A rebate paid before the relevant wholesaler invoice is due may create little additional financing expense. A different experience is possible when inventory moves slowly, submissions are incomplete, credit terms are tight or reconciliation is difficult. The pilot’s practical effects will need to be assessed across different provider types and purchasing models.

Who Bears the Financial and Administrative Costs?

The answer is not a single stakeholder. The revised pilot assigns some obligations explicitly, while other costs depend on how organizations purchase drugs, operate their systems and contract with service providers.

Participant

Responsibility or potential exposure

Manufacturers

Fund the required data-submission platforms; validate eligible submissions; pay or document denials on time; provide technical assistance and required reporting.

Covered entities

Manage purchasing and eligible-claim submissions; reconcile rebates; potentially absorb internal system, training, staffing and working-capital costs.

Third-party administrators and technology vendors

Perform data extraction, submission, monitoring and reconciliation under their contracts; compensation and liability for additional services depend on those agreements.

Wholesalers

Existing invoice, credit and payment terms influence whether the covered entity receives its rebate before the acquisition invoice is due.

HRSA estimates an average annual claims-reporting cost of approximately $34,320 per covered entity under its information-collection analysis, with actual costs varying by entity type. This is an average regulatory estimate, not a prediction of what any particular hospital will spend. Manufacturers are required to fund the submission platforms, but that does not necessarily cover all costs of a covered entity’s internal preparation, integration, monitoring or dispute management. [1, pp. 48,892–48,894]

The contractual questions follow naturally. Who corrects an incomplete claim? Who tracks the restarted payment deadline? Which party carries the cost of an error, additional integration work or a reconciliation backlog? Existing arrangements may address some of these questions, but organizations should not assume every agreement was written for a rebate workflow.

Contract Pharmacy Considerations

Contract pharmacy arrangements add another operational layer. A covered entity may rely on a retail or specialty pharmacy partner to dispense eligible drugs and on an administrator to determine eligibility and manage replenishment. The covered entity retains responsibility for 340B compliance, even when other organizations perform parts of the workflow. HRSA’s notice includes contract pharmacy arrangements in its discussion of the pilot and acknowledges the complexity of coordinating claims and transaction data across these relationships. [1, pp. 48,887–48,888, 48,893–48,894]

Depending on the arrangement, the parties may need to clarify who gathers and submits transaction data, corrects incomplete submissions, tracks rebate payments and resolves discrepancies. Existing contract pharmacy and administrator agreements should be reviewed for data-sharing permissions, confidentiality, reconciliation duties, payment allocation and dispute procedures. The extent of any changes will depend on how the covered entity already operates and the terms of its contracts.

Data, Denials and the Limits of Verification

The revised pilot requires defined data elements, appropriate safeguards for personal and health information, reconciliation reporting and documented reasons for rebate denials. Under the notice, manufacturers may not deny a rebate based on covered-entity eligibility concerns, diversion, Medicaid duplicate-discount concerns or perceived insufficient WAC purchases. Those issues must instead be raised with HRSA or pursued through the program’s established audit and dispute mechanisms. The notice permits certain documented denials, including when a rebate would duplicate an applicable Medicare Maximum Fair Price discount or when another covered entity has already received a 340B rebate on the same claim. Because the pilot concerns selected Medicare-negotiated drugs during their price applicability periods, MFP nonduplication is part of the pilot’s design. [1, p. 48,903]

These provisions limit the grounds for denial without eliminating the need for claim validation and dispute management. Covered entities and their service providers should establish who reviews rejected submissions, corrects incomplete data, preserves records, monitors payment deadlines and escalates recurring problems. Relevant contracts should address data use, privacy, audit rights, service standards and responsibility for errors.

The Legal and Medicare Payment Context

The revised pilot follows an earlier program scheduled to begin in January 2026. On December 29, 2025, a federal district court preliminarily enjoined the earlier program, finding that HRSA had likely failed to adequately consider hospitals’ reliance on upfront discounts. HRSA subsequently withdrew that program. On February 10, 2026, the district court granted the parties’ joint motion for vacatur and remand, vacating the earlier notices and manufacturer approvals. Neither order was a final ruling on the lawfulness of rebate mechanisms generally; the revised 2026 pilot is a distinct agency action. [3, 4]

In a separate dispute, the D.C. Circuit held in July 2026 that Section 340B permits rebate mechanisms when the Secretary of Health and Human Services affirmatively provides for them, but manufacturers may not impose such models unilaterally without Secretarial approval. The court did not decide whether any particular proposed arrangement should receive approval or resolve possible procedural challenges to the revised pilot. [5]

A separate proposal could also affect hospital financial planning in 2027. In its CY 2027 Hospital Outpatient Prospective Payment System proposed rule, CMS proposed paying most separately payable 340B-acquired drugs at average sales price minus 33.4%, rather than the generally applicable ASP plus 6% rate. CMS estimated lower Medicare drug and beneficiary payments, with a corresponding budget-neutral increase in other outpatient payments. As of September 2026, this remains a proposal, not a finalized payment change or an additional requirement of the HRSA rebate pilot. Financial effects would vary across hospitals. [6]

Hospitals evaluating the pilot may therefore want to model the acquisition and rebate process separately from potential Medicare payment changes, then consider their combined impact if both policies ultimately take effect.

Five Questions Organizations Should Ask

Financial exposure: For affected drugs, when do we purchase, dispense, submit claims, receive rebates and pay our wholesalers?

Operational readiness: Can existing pharmacy, claims and accounting systems support the required reporting and reconciliation processes?

Contracting: Do vendor and administrator agreements clearly assign responsibility for errors, incomplete submissions, payment tracking, disputes and additional service costs?

Data and compliance: Are approved data uses, privacy safeguards, reporting obligations and denial-review procedures clear?

Policy status: Who will track HRSA guidance, relevant litigation and the separate CMS payment proposal?

What the Pilot May Tell Us

The pilot applies to a small share of total 340B sales, but it offers a defined setting in which to measure how a claims-based rebate process works. Relevant evidence will include actual payment timing, administrative expense, rejection and dispute rates, platform performance and the differences among covered entities with distinct purchasing and technology arrangements. A broader shift is not predetermined by this limited pilot.

The practical question is whether participating organizations can deliver the required data, obtain accurate and timely rebates, allocate operational responsibilities and understand the costs they incur. Those results, rather than assumptions about how either model should perform, will provide a more useful basis for evaluating the program.

How Lanton, Lanton & Sosa Law Can Help

Lanton, Lanton & Sosa Law advises healthcare and life sciences organizations on pharmaceutical reimbursement, regulatory compliance, commercial contracting and pharmacy operations. As 340B requirements evolve, we help clients evaluate the rules affecting their businesses, review agreements and address implementation and compliance questions.

Organizations reviewing new rebate arrangements, technology or administrator contracts, or changes to purchasing and reimbursement can contact the firm to discuss their specific circumstances: www.lantonlaw.com/contact.

This publication is provided for general informational purposes only and does not constitute legal advice. Regulatory guidance, litigation and Medicare payment policies may change.

Selected Sources

[1] Health Resources and Services Administration, Notice Regarding 340B Rebate Model Pilot Program, 91 Fed. Reg. 48,883–48,903 (Aug. 3, 2026), especially 48,884–48,886 (statutory framework and MFP), 48,892–48,894 (cost analysis and pilot scope), and 48,902–48,903 (plan requirements and denials). https://www.govinfo.gov/content/pkg/FR-2026-08-03/pdf/2026-15633.pdf

[2] HRSA, Revised 340B Rebate Model Pilot Program announcement (July 31, 2026). https://www.hrsa.gov/about/news/press-releases/revised-340b-program-2026

[3] American Hospital Association v. Kennedy, 820 F. Supp. 3d 30, 44 (D. Me. 2025) (preliminary injunction concerning the earlier pilot, Dec. 29, 2025). https://docs.justia.com/cases/federal/district-courts/maine/medce/2%3A2025cv00600/69459/90

[4] American Hospital Association v. Kennedy, Order Granting Joint Motion for Vacatur and Remand (D. Me. Feb. 10, 2026). https://docs.justia.com/cases/federal/district-courts/maine/medce/2%3A2025cv00600/69459/115

[5] Novartis Pharmaceuticals Corp. v. Kennedy, No. 25-5177 (D.C. Cir. July 21, 2026) (approval required before manufacturers may implement rebate arrangements unilaterally). https://law.justia.com/cases/federal/appellate-courts/cadc/25-5177/25-5177-2026-07-21.html

[6] CMS, CY 2027 Hospital Outpatient Prospective Payment System Proposed Rule Fact Sheet (July 2, 2026). https://www.cms.gov/newsroom/fact-sheets/calendar-year-2027-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center

Germany’s Drug-Pricing Investigation: When Trade Pressure Creates More Uncertainty

The U.S. trade debate over drug pricing is moving into European reimbursement policy. Germany is now one of the clearest examples.

A recent Pink Sheet article by Francesca Bruce examined whether the U.S. Trade Representative’s Section 301 investigation into Germany’s drug-pricing system could produce consequences beyond its stated goal.

This is about more than the price of a single medicine. The investigation could affect how manufacturers plan launches, generate evidence, allocate investment and evaluate the European market.

Germany’s pricing system is part of a larger structure

Germany’s drug-pricing decisions do not occur in a vacuum. Reimbursement is tied to clinical evidence, negotiated assessments, statutory requirements and the role of sickness funds. Those decisions affect how manufacturers estimate revenue and plan commercial activity across Europe.

A U.S. investigation focused on German pricing therefore reaches beyond one national reimbursement system. Manufacturers may delay a launch while they assess whether a pricing decision could trigger additional U.S. scrutiny. They may also reconsider investment in a market where reimbursement policy has become part of a broader trade dispute.

Trade pressure does not automatically improve access

The question is whether pressure on Germany will improve access or make the system harder to navigate.

A company facing greater uncertainty may change launch timing, limit investment or take a more cautious approach to evidence generation. Those decisions can affect medicine availability even when the underlying dispute is about price.

Trade policy also has to account for the differences between the U.S. and European systems. A price that appears low in one market may reflect a different reimbursement structure, purchasing system or approach to clinical value. Treating those differences as evidence of unfair conduct can produce a remedy that does not address the reason prices differ.

The European effect

Germany is one of Europe’s largest pharmaceutical markets. Policy changes there are watched closely by manufacturers, payers and governments throughout the region.

If German reimbursement rules change because of U.S. trade pressure, other European countries may consider whether similar scrutiny could reach their own systems. That uncertainty would not stay in Germany. It could affect negotiations, joint purchasing, launch decisions and investment across Europe.

The risk of a policy misfire

Germany’s pricing system should still be scrutinized. The analysis has to distinguish between a structure that reflects a different health system and conduct that genuinely harms competition or access.

The United States and Germany also have to consider the broader trading relationship. A dispute over pharmaceutical pricing can become part of a larger argument about market access, industrial policy and the treatment of European companies in the U.S. market.

For healthcare executives, this is a market-access issue, not just a trade headline. Its consequences may appear in launch sequencing, reimbursement negotiations, investment planning and patient access before any formal policy change takes effect.

Read Francesca Bruce’s Pink Sheet article, “Could USTR German Pricing Investigation Lead To Policy Misfire And Damaged Trading Relations?”, for the full discussion.

Lanton, Lanton & Sosa Law PLLC advises healthcare and life-sciences companies on legal and policy issues involving pricing, reimbursement, market access and cross-border strategy. Lanton Strategies International provides related policy and market analysis across the United States and Europe.

What Rutledge Still Means for PBM Regulation

Pharmacy benefit managers are facing renewed scrutiny from state legislatures, Congress and federal agencies. The central legal issue is not whether PBMs can be regulated. It is which kinds of regulation can survive federal preemption rules.

Our new analysis in Pharmaceutical Executive, “The Legacy of Rutledge: What States and Congress Can Still Regulate Pharmacy Benefit Managers,” examines how the legal framework is developing.

Lanton, Lanton & Sosa Law PLLC advises pharmacies, healthcare organizations, employers and regulated businesses on PBM contracts, reimbursement, pharmacy regulation, 340B, government affairs, compliance and healthcare transactions.

The short version

In Rutledge v. Pharmaceutical Care Management Association, the Supreme Court upheld an Arkansas law requiring PBMs to reimburse pharmacies at or above certain acquisition-cost levels and provide an appeals process.

The Court treated the law as regulation of pharmacy costs. It did not view the statute as directing the design or administration of an ERISA health plan.

The Tenth Circuit’s decision in Pharmaceutical Care Management Association v. Mulready identified a different boundary. Provisions affecting pharmacy networks and preferred-network participation may face preemption when they begin to control how an ERISA plan or Medicare Part D benefit is structured and administered.

The two decisions should be read together:

• States retain room to regulate reimbursement, payment practices, MAC lists, dispensing fees and appeals.

• States face greater risk when laws dictate network design, benefit structure or plan administration.

• Congress can address areas that may be difficult for states to regulate, including PBM compensation, fiduciary duties, ownership, kickbacks, audit rights and pharmacy access.

Why this matters to pharmacy executives

The legal analysis is connected to daily operations. A pharmacy should know what it was paid at the point of sale, what fees were later imposed, how the final reimbursement was calculated and whether the contract provides a meaningful appeal or audit process.

Specialty pharmacies should review whether retail-oriented performance measures accurately reflect complex dispensing, patient-support and clinical services.

Covered entities and contract pharmacies should also examine 340B documentation, manufacturer restrictions, duplicate-discount controls, inventory procedures and audit records.

Employers and plan sponsors should identify direct and indirect PBM compensation, affiliated arrangements, spread pricing, formulary incentives and the practical value of their audit rights.

What to review now

A focused review should cover:

1. PBM reimbursement and reconciliation data.

2. MAC-list and appeal procedures.

3. Contract terms governing audits, fees and termination.

4. Network and specialty-pharmacy provisions.

5. 340B contract-pharmacy and documentation practices.

6. The effect of new federal reporting and fiduciary requirements.

The policy debate will continue through legislation, litigation, agency action and contract negotiations. The organizations best prepared for the next phase will be the ones that understand their contracts, payment data and operational records before a dispute begins.

Read the full analysis in Pharmaceutical Executive: The Legacy of Rutledge: What States and Congress Can Still Regulate Pharmacy Benefit Managers.

This article is for general informational purposes only and does not constitute legal advice.

The Legal Questions Behind a Pharmaceutical Manufacturing Move

A pharmaceutical company considering a new U.S. manufacturing site is not making a single decision. It is taking on a series of legal, regulatory and commercial questions at the same time.

Ipsen is reportedly evaluating whether to establish a U.S. manufacturing facility while continuing to invest in its U.K. operations. No final decision has been announced. Still, the issue illustrates what companies must examine when production strategy begins to shift. The Wall Street Journal, September 11, 2026

The first question is whether the company should build, acquire, expand an existing facility or use a contract manufacturer. Each path creates different obligations involving financing, real estate, construction, environmental review, licensing, employment and supply agreements.

The regulatory analysis is just as important. A facility may need to meet FDA requirements, address changes to manufacturing processes and maintain compliance during a transition. Moving production from one country to another can also affect inspections, documentation, release procedures and responsibilities between related companies and outside vendors.

Government incentives add another layer. Tax credits, grants and other programs may make a U.S. project more attractive, but they often come with eligibility rules, reporting requirements, employment commitments or limits on how funds may be used.

Trade policy also matters. Tariffs, country-of-origin rules and future changes in U.S. policy can affect the economics of a facility long after the initial investment decision has been made.

The legal work should begin before a company chooses a site. By then, the company should understand the regulatory pathway, the incentives it may qualify for, the contractual structure it needs and the risks of changing production later.

Manufacturing strategy is now part of the broader business strategy. Companies that treat it as only a real-estate or operations project may miss the legal and commercial consequences.

At Lanton, Lanton & Sosa Law PLLC, we help healthcare and life-sciences companies think through the legal, regulatory and government-affairs issues that arise when manufacturing, investment and market strategy begin to overlap. The earlier those questions are addressed, the more options a company usually has.

This article is for general educational purposes only and does not constitute legal advice. Specific manufacturing, regulatory, incentive and transactional questions should be reviewed with qualified counsel.

U.S. Most-Favored-Nation Drug Pricing Raises Questions Beyond the Price of Medicines

The renewed focus on most-favored-nation drug pricing in the United States is often discussed as a straightforward question of whether the government can bring American drug prices closer to those paid in other countries. The consequences could be much broader.

I recently spoke with Jen Brogan of APM Market Access about several of those issues, including how pharmaceutical manufacturers may approach future drug launches, what happens when pricing decisions in one country begin affecting another market, and whether countries outside the United States could face additional pressure as the policy develops.

One of the biggest questions is launch sequencing. Pharmaceutical companies do not make launch decisions one country at a time without considering what happens elsewhere. If a lower price negotiated in one market can eventually influence the price available in the United States, companies may have to reconsider where and when certain products are introduced. The answer may also differ considerably depending on the drug, its patient population, available alternatives and the economics surrounding the product.

APM Market Access examined that issue in “U.S. MFN could shift pharma launch sequencing ‘per class of drug’ – legal expert”.

The policy may also affect products already on the market differently from new medicines. Existing products already have established pricing, reimbursement arrangements and commercial expectations across multiple countries. That can make changing the economics surrounding those products particularly complicated.

APM addressed that question in “MFN could put greater short-term pressure on existing drugs than new launches – pricing expert”.

There is also a legal issue that deserves attention. International reference pricing can create situations where pricing information or arrangements in one market begin influencing decisions in another. That does not automatically create an antitrust problem. It does mean companies need to pay close attention to how pricing information is obtained, communicated and used when commercial decisions are being made across markets.

That issue was discussed in “U.S. MFN policy raises potential ‘antitrust’ questions over cross-market drug pricing, says legal expert”.

Finally, this is not only a U.S. policy discussion. Countries with significant pharmaceutical industries and comparatively lower medicine prices may find themselves part of the debate.

Switzerland is a particularly interesting example. It is home to some of the world's largest pharmaceutical companies, while the country is also dealing with its own questions about pharmaceutical competitiveness, research investment and the economics of maintaining a strong life sciences sector. If the United States places greater importance on international price comparisons, Switzerland and other European markets could face difficult choices between controlling domestic healthcare spending and maintaining an environment that attracts pharmaceutical investment.

APM explored that issue in “Switzerland could become target of U.S. pressure on drug pricing, says legal expert”.

Taken together, these questions illustrate why MFN cannot be evaluated solely by looking at the price of a prescription today. Drug pricing policy can affect launch decisions, investment, competition, reimbursement and the relationship between pharmaceutical markets around the world.

For pharmaceutical manufacturers, healthcare organizations, policymakers and investors, the important question will be how those consequences develop as the policy moves from announcement to implementation.

APM Market Access Coverage

U.S. MFN could shift pharma launch sequencing ‘per class of drug’ – legal expert
APM Market Access

MFN could put greater short-term pressure on existing drugs than new launches – pricing expert
APM Market Access

U.S. MFN policy raises potential ‘antitrust’ questions over cross-market drug pricing, says legal expert
APM Market Access

Switzerland could become target of U.S. pressure on drug pricing, says legal expert
APM Market Access

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