Trump Administration's Voluntary MFN Drug-Pricing Agreements Reshape Strategy at Pfizer, AbbVie, and Bristol Myers Squibb
Key Insights
Since late 2025, the Trump administration has reached voluntary most-favored-nation pricing agreements with 17 major pharmaceutical manufacturers representing roughly 86% of the branded U.S. pharmaceutical market.
Pfizer became the first to sign, offering discounts on more than 30 branded medicines while facing a projected $1.5 billion decline in COVID-related revenue.
AbbVie (search) enters from a position of strength with Skyrizi generating nearly $4.5 billion in Q1 2026 sales (up 31% YoY) and Rinvoq reaching roughly $2.1 billion (up 23% YoY), offsetting Humira's decline.
Since late 2025, the Trump administration has pursued voluntary most-favored-nation (MFN) pricing agreements with many of the world's largest pharmaceutical manufacturers, reaching deals with 17 companies that collectively represent roughly 86% of the branded U.S. pharmaceutical market as of April 2026. These agreements generally align prices for certain drugs with those paid in comparable developed countries, expand discounted direct-to-consumer purchasing through the TrumpRx platform, and provide MFN pricing for certain Medicaid purchases. The question now confronting investors and industry executives alike is whether lower drug prices will automatically translate into lower profits — and the answer varies considerably by company.
Pfizer: First Mover with a Revenue Gap to Fill
Pfizer became the first major pharmaceutical company to reach an agreement with the administration, offering discounts on more than 30 branded medicines. Management has framed the initiative as a way to improve affordability while preserving incentives for pharmaceutical innovation.
While lower prices generally mean the company makes less per prescription, Pfizer has another problem that arguably matters more: it needs to replace revenue lost from the decline of its COVID-19 products. The company's own projections assume an additional $1.5 billion decline in COVID-related revenue, separate from revenue pressure caused by patent expirations. In response, Pfizer is investing heavily in oncology, vaccines, and obesity treatments while pursuing additional cost reductions. A clearer pricing framework, even if it results in somewhat lower prices, could reduce regulatory uncertainty and help management make longer-term capital allocation decisions.
AbbVie (search): Positioned for Strength with Skyrizi and Rinvoq
Compared to Pfizer, AbbVie (search) enters this environment from a position of strength. Humira, once the world's best-selling drug, has already faced years of biosimilar competition, and management spent considerable time preparing for that transition with newer immunology drugs Skyrizi and Rinvoq, which now drive much of the company's growth.
Skyrizi has become one of AbbVie (search)'s most important growth drivers, generating nearly $4.5 billion in first-quarter 2026 sales, up 31% from a year earlier. Rinvoq continues delivering strong growth across multiple autoimmune diseases, including rheumatoid arthritis (search), Crohn's disease (search), ulcerative colitis (search), and atopic dermatitis (search). In the first quarter, Rinvoq revenue increased 23% year over year to roughly $2.1 billion, making it one of AbbVie's fastest-growing blockbuster medicines. Together, the two therapies are generating billions of dollars in annual revenue and are expected to more than offset the decline in Humira sales over the next several years, leaving AbbVie less dependent on a single blockbuster drug and better positioned to absorb future pricing pressure.
Bristol Myers Squibb (search): Racing to Fill the Patent Cliff
Bristol Myers Squibb (search) faces a different challenge, as drug pricing is not its only issue. Several of its top-selling products are already approaching or facing patent expirations. Revlimid has been steadily losing revenue as generic competition expands, while Eliquis, its blockbuster blood thinner co-marketed with Pfizer, is expected to face similar pressure later this decade. Together, those products have generated tens of billions of dollars in annual sales, leaving Bristol Myers with a significant revenue gap to fill.
Management has responded by launching newer medicines, expanding its late-stage pipeline, and pursuing acquisitions to strengthen its oncology, immunology, and cardiovascular portfolios. Whether those newer therapies can replace the revenue lost from aging blockbusters will likely have a much greater impact on long-term earnings than modest changes in drug pricing.
Industry Adaptation and the Path Forward
Rather than mounting broad public opposition, many large pharmaceutical companies have chosen to negotiate. The agreements may also provide other benefits, including tariff relief for participating manufacturers that expand U.S. production under separate administration policies. Investors generally dislike regulatory uncertainty more than they dislike modest reductions in profitability, and complying rather than fighting has emerged as the most reasonable strategy.
Drug pricing is becoming a larger factor in pharmaceutical investing, but it should not become the only factor. Pipeline quality, research productivity, acquisitions, and manufacturing execution will continue driving long-term shareholder returns. For Pfizer, the priority remains rebuilding growth beyond COVID products. For AbbVie (search), it is sustaining momentum from Skyrizi and Rinvoq. For Bristol Myers, success depends largely on replacing aging blockbuster products with next-generation therapies. The new pricing agreements certainly change the industry's operating environment, but they do not eliminate what has always mattered most in pharmaceuticals: companies that consistently develop valuable new medicines tend to create the most value for shareholders over time.