As experts on US market access, CELforPharma faculty members Nick Proctor and Louisa Oliver Byrne, expert-trainers of the Understanding Pharma Market Access in the US course, have been closely monitoring the evolution of drug pricing reforms, with particular attention to the Most Favored Nation (MFN) proposals. These proposals aim to tie the prices of certain medicines in the US to the lowest list prices available across a set of OECD countries, and they have the potential to reshape both the American and global pharmaceutical markets.
đź’Ľ Impacts for payers
- With manufacturers offering their products for sale direct to consumers there is pressure on gross-to-net margins.
- With MFN pressuring WAC pricing across all channels, and MFP pressuring Medicare prices in highly competitive categories, there is increased complexity in price management for payers operating across commercial and government channels.
đź’Š Impacts on patients
- Although the direct-to-patient discounts seem large, they may well end up costing patients more for their medicines.
- For Medical Benefit products, providers may be reluctant to administer treatments with uncertain provenance.
- Payers exiting markets or adapting their business models could result in higher deductibles and/or insurance premiums.
🏠Impacts for manufacturers
- Global price strategy scenario planning to accommodate shifts in list and/or net price dynamics, launch sequencing, and commercial launch planning.
- Implementation of compliant direct-to-patient channels, and price-setting to align with stated policy objectives.
- Need for agile, strategic, and holistic global P&MA and policy decision frameworks.
The future of MFN remains uncertain. Proposals have faced political, legal, and operational hurdles, and their implementation could vary greatly depending on administration priorities. The debate nevertheless highlights persistent political and public pressure for drug pricing reform in the US.
This insight is based on the whitepaper “Market Access in the IRP Era: Scenarios to Plan for an Uncertain Future (2025)”, authored by Nick Proctor and Louisa Oliver Byrne. The full paper is available for download here.
🎓 If you want to learn about:
- The structure and key players of US Managed Care systems, and how they compare with other global systems.
- The scope of medical benefit and how to navigate the pricing and access control mechanisms in this system.
- The role and significance of Pharmacy Benefit Managers (PBMs) and how to navigate the pricing and access control mechanisms in the pharmacy benefit system.
- The tools and context needed to understand and discuss the potential future impact of the Inflation Reduction Act, increased PBM transparency, and other recent policy decisions.
- Strategies for navigating towards successful market access and how to deal with the most common challenges along the way.
👉 Attend Dr Nick Proctor & Louisa Oliver Byrne’s highly praised 1-day course:
Understanding Pharma Market Access in the US
With Dr Nick Proctor & Louisa Oliver Byrne
