Just because several major pharmaceutical companies have signed drug pricing agreements with the White House, the issue of Most Favored Nation (MFN) drug pricing is expected to remain a significant challenge for the industry into 2026.
Greg Graves, senior partner for McKinsey’s life sciences practice, told BioSpace, “The biopharma world is adapting to an environment with a lot more policy and geopolitical uncertainty than we’ve had in the past. We have new sources of uncertainty that we’re having to absorb beyond the traditional commercial potential, technical risk, regulatory risks.”
Graves explained that MFN drug pricing was a defining issue in 2025, compounded by tariff threats used by the president to pressure companies into lowering prices. He noted that while these policy changes were underway, pharmaceutical companies still faced routine business pressures such as loss of exclusivity events and portfolio management. According to Graves, “MFN was a bolt of lightning through pharma C-suites, particularly putting pressure on the CEO.” He added, “I don’t think any one person except the CEO can solve the MFN question or at least figure out how you’re going to address it.”
Several large companies—including Pfizer, AstraZeneca, Amgen, Novo Nordisk and Eli Lilly—reached agreements with the White House in late 2025. Additional firms like Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead Sciences, GSK, Merck, Novartis and Sanofi also signed on before year-end. However, some companies such as Biogen have not participated yet. Biogen CEO Chris Viehbacher recently told Stifel that MFN has not affected his company so far and would likely only impact new product launches if it does.
“Mr. Viehbacher does believe the worst has passed,” Stifel wrote after meeting with him. “For the industry though, the looming threat of MFN if this does persist may create more thought on how to price new drugs in different markets in the world.”
When President Donald Trump first raised MFN proposals earlier in 2025 there was significant concern within the industry. Some CEOs advocated for other countries to pay higher prices for innovative medicines; this approach reportedly influenced U.S. policy decisions regarding international drug pricing.
According to William Blair’s year-end outlook report: “We believe investors are beginning to view the existential risks to the industry as unlikely to materialize and believe next year is setting up to be a better year than this year for the first time in several years.”
Pfizer executives acknowledged relief after signing their agreement: “It relieves a significant headwind and allows us to be much more planful and certain about the environment in which we’ll operate in,” said CFO Dave Denton.
Industry analysts noted that Pfizer negotiated terms covering many drugs already facing price declines or patent expirations. However CEO Albert Bourla stated during guidance calls that effects from MFN are not insignificant: “I think you should assume there is an impact as we always said.” Pfizer recently lowered its 2026 revenue guidance below analyst expectations.
Graves observed that less than half of top pharmaceutical firms have signed deals so far: “We’re still in the early innings of dealmaking,” he said. The biotech sector has yet to begin negotiations.
Guggenheim Securities reported that after key MFN deals were signed in 2025 pharma stocks outperformed broader market indices—suggesting improved investor confidence—and predicted a more stable outlook for 2026 focused on sales growth and clinical execution.
However questions remain as direct-to-consumer platforms like TrumpRx prepare for launch alongside these new agreements. PitchBook commented: “Despite headline price reductions, it remains uncertain whether the TrumpRx model will meaningfully lower patient out-of-pocket cost although benefit to pharma companies is clear as they avoid potential heavy import tariffs.”
The Trump administration’s focus has largely been on large pharmaceutical firms rather than smaller biotechs so far—a situation Graves described as risky for smaller players heading into 2026 due to their limited resources compared with larger competitors.
Viehbacher expressed skepticism about Congress enacting permanent MFN-style legislation but warned ongoing disruptions at agencies like FDA could disproportionately affect smaller biotechs needing frequent regulatory interactions.
A recent ICON Global survey found growing concern among biotech leaders over changing regulatory requirements—with 66% citing regulatory change as impactful for their organizations in 2025 compared with 56% two years earlier—and increased worries about geopolitical uncertainty rising from 26% two years ago up to 53%.
The ICON survey concluded: “Regulatory policy and tariff changes will undoubtedly impact biotechs worldwide. Whether those impacts will be positive or negative remains to be seen and will depend on individual companies’ abilities to maximize opportunities and mitigate threats.”
