Lancet Modeling Study Warns Medicare Most-Favored-Nation Pricing Could Reshape Global Drug Launch Strategy
核心洞察
A modeling study in The Lancet (搜索) projects Medicare (搜索)'s most-favored-nation pricing policy would cut spending by $5.2 billion under GLOBE and $6.4 billion under GUARD in its initial phase.
For roughly three in four medicines studied, Medicare (搜索) savings would approach four times that drug's entire annual sales in the reference country, creating incentives to alter pricing abroad.
Reported confidential agreements with 17 manufacturers could reduce the policy's projected Medicare (搜索) savings by 71 percent, according to the analysis.
Medicare (搜索)'s most-favored-nation (MFN) pricing policy could deliver substantial federal savings while pushing manufacturers to raise prices or delay launches outside the United States, according to a modeling study published in The Lancet (搜索). The analysis estimates the policy would cut Medicare prescription drug spending by $5.2 billion (16 percent) under the GLOBE model, which covers medicines administered in hospitals and clinics, and $6.4 billion (18 percent) under GUARD, which covers pharmacy-dispensed medicines, during an initial phase covering about 25 percent of the Medicare program.
If expanded to all Medicare (搜索) beneficiaries, those savings could rise to an estimated $21 billion under GLOBE and $25.5 billion under GUARD, the study projects.
Manufacturer Incentives and Side Deals
The study's central concern is the incentive structure the policy creates abroad. For about three in four medicines studied, the resulting Medicare (搜索) savings would be worth almost four times that medicine's entire annual sales in the country used to set its price. That gap, the authors suggest, could give manufacturers a strong incentive to change how they price and launch products outside the USA.
The analysis also estimates that reported confidential deals between manufacturers and the Trump administration could erode the policy's financial impact. For the initial group of 17 manufacturers with announced agreements, the study's projected savings would be cut by 71 percent.
"The Trump administration's Most-Favored-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realized," said Prof. Thomas Hwang of Brigham and Women's Hospital, lead author of the study.
Policy Mechanics
Medicare (搜索) is the US government health insurance program covering around 68 million older and disabled people. It was historically barred from negotiating medicine prices directly with manufacturers until the 2022 Inflation Reduction Act (搜索) authorized negotiation for a small number of costly medicines. The MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, adjusted for purchasing power. Under the GLOBE and GUARD models, a randomly selected 25 percent of Medicare beneficiaries would be covered over a five-year period.
Because both models tie Medicare (搜索) payment to prices charged in other countries, the study notes they could reshape drug pricing and market strategy outside the USA as manufacturers respond to the new US benchmarks.
Medicaid Expansion Under the Same Framework
The Medicare (搜索) analysis follows a White House announcement that all 50 states' Medicaid (搜索) programs will receive lower prescription drug prices under agreements with pharmaceutical manufacturers to match the lowest prices paid by other developed nations. Under the arrangement, described as the GENEROUS Medicaid Payment Model, participating manufacturers will provide state Medicaid programs with rebates on expensive brand-name drugs so the final price to Medicaid does not exceed the MFN price.
The model covers hundreds of individual drugs across virtually all major drug classes, including oncology, diabetes (搜索) care, and asthma (搜索) treatments. The White House said Medicaid (搜索) programs have already received one million free prescriptions of Eliquis, an anticoagulant used in heart disease, under the MFN deals.
The Council of Economic Advisers estimates taxpayers will save $64.3 billion over the next decade in lower Medicaid (搜索) drug costs across all 50 states, with $36.6 billion accruing to the federal government and $27.6 billion to state governments, since Medicaid costs are shared between both. The Council separately estimates total savings from the MFN deals at $600 billion over the next decade.
Direct-to-Consumer Channel Draws Scrutiny
The MFN agreements also extend to direct-to-consumer purchases through TrumpRx (搜索).gov, which the White House says guarantees MFN prices on all new innovative medicines brought to market. Since its February launch, the White House states patients have saved more than $700 million on medicines through the site, including discounts on obesity (搜索) and infertility treatments. In July 2026, seniors without GLP-1 (搜索) coverage for obesity gained access at $50 per month; the White House says 600,000 seniors have since saved a total of $216 million.
That channel has drawn criticism. Reporting in The Nation argues that many TrumpRx (搜索) prices were already available elsewhere, often through the existing purchasing portal GoodRx (搜索), and that other prices are higher than those charged in many other Western countries. The outlet notes that TrumpRx does not accept insurance, so for the 85 percent of Americans with some level of drug coverage, its discounted price will almost always be higher than what they would otherwise pay. It also reports that users are often steered toward expensive brand-name medications even when cheaper generic alternatives are available through retailers such as Costco and Cost Plus.
The Nation further reports that Health and Human Services Secretary Robert F. Kennedy Jr. did not provide evidence for the $700 million savings figure when pressed by Senator Elizabeth Warren. The outlet also cites pharmaceutical lobbying group PhRMA (搜索)'s political donations, including more than $42 million to congressional Republicans since the 2010 Citizens United decision and $1 million to the Trump Inaugural Committee, with Eli Lilly, Hims & Hers (搜索), Pfizer, Merck (搜索), Johnson & Johnson, and Gilead among other donors whose products appear on the site.
The White House frames the policy as ending the practice of charging American patients up to three times more than patients in other developed nations for the same drug. The Lancet (搜索) study's authors do not dispute the potential for savings, but point to participation as the decisive variable: the difference between the projected billions and the 71 percent reduction modeled under announced manufacturer agreements rests on whether companies join the models directly or negotiate around them.