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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