Big drug companies are aligning with President Donald Trump’s “most-favored-nation” (MFN) drug pricing policy, but the details of the negotiated concessions and their actual impact on drug affordability in the United States remain unclear.
Now, as these most-favored-nation benefits come under increasing scrutiny from patient advocates and others, and on the heels of efforts by Democratic lawmakers to push for more details in late 2025, Democratic Sen. Ron Wyden (R-Ore.), ranking member of the Senate Finance Committee, is seeking answers directly from drug companies.
Sponsored by six other Senate Democrats, Wyden sent 11 letters to as many drug manufacturers as possible, asking for clarification on whether there is “evidence that these transactions benefit American patients and taxpayers in terms of savings to the Medicaid program,” according to a March 6 press release.
Among other things, the senator’s study asks drug companies with MFN agreements to provide information about which drugs are covered by the agreements, what the MFN prices are for those drugs, and how much state Medicaid programs are actually expected to pay following the announcement.
The Senate Finance Committee said letters were sent to AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Roche Genentech, Gilead Sciences, GSK, Johnson & Johnson, Merck & Company, Novartis and Sanofi.
Fierce Pharma has contacted both companies for comment.
The latest mass letter comes after Wyden and other senators made similar requests to Pfizer, AstraZeneca, Novo Nordisk and Eli Lilly in December.
According to the letter (PDF), Wyden and other senators’ concerns about MFN are driven, at least in part, by Trump’s passage of the Republican reconciliation bill on July 4 of last year that cut nearly $900 billion from the U.S. Medicaid program.
Given the thinner margins states’ Medicaid programs now have to operate, the letter continues, lawmakers specifically want to know whether “the prices[companies]offer for these drugs are actually lower than the net prices that states currently receive for the same products in Medicaid,” the letter continues.
Wyden and the senators gave drug companies until March 23 to respond and stressed that states need timely access to information to make budget decisions related to the loss of Medicaid funding.
Surveillance will be strengthened
Skepticism about MFN and other related businesses, such as TrumpRx.gov, the government’s cash-pay drug purchasing portal, appears to be growing among President Trump’s critics and supporters alike.
In late January, consumer advocacy group Public Citizen filed a Freedom of Information Act (FOIA) lawsuit against the Department of Health and Human Services to extract more information about the government’s opaque MFN agreements.
“Mr. Trump and RFK Jr. have promised ‘radical transparency,'” Peter Maberdach, Director of Access to Medicines at Public Citizen, said in a release at the time. “In exchange, they gave us secret deals with drug companies.”
Maybaldach added that the “secrecy” surrounding the deal makes it impossible to determine its effectiveness in lowering specific drug prices.
Meanwhile, about 50 leaders of free market and conservative groups wrote a letter (PDF) to Congress in February, urging lawmakers to reject President Trump’s most-favored-nation policy, which they suggested would “import socialist price controls and values into our country.”
The organizations began their push after President Trump’s Great Health Plan, announced earlier this year, called on Congress to codify the president’s Most Favored Nation policy.
And last month, John Burkett, a former senior policy adviser in the Biden administration, agreed that more details are needed about recent government-industry partnership plans.
“I think it’s beneficial for all parties to clarify what the deal actually is,” Burkett said in a recent interview with Fierce. “In the Oval Office, administration leaders stood up and said, ‘This is the largest drug pricing agreement in history.’ It’s a strange thing to say when you don’t want to reveal the details.”
Burkett also questioned whether the prices negotiated by MFN might differ from the prices paid by Medicaid, and what impact, if any, the policy would have on people with Medicare or commercial insurance.
So far, the following major pharmaceutical companies have signed MFN agreements with the White House: AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, BMS, Lilly, Merck KGaA’s EMD Serono, Genentech, Gilead, GSK, J&J, Merck, Novartis, Novo Nordisk, Pfizer, and Sanofi.
Although the exact terms remain confidential, the details of the deal being touted are similar, including winning concessions from drug companies to discount the list price of some drugs, expand direct-to-consumer sales channels and list certain drugs on TrumpRx.gov. Many companies have cited some examples of drugs for which they plan to offer discounts, but the full scope of the deal remains unclear.
Typically, in exchange for promises to invest in new U.S. infrastructure projects, multinational companies also obtained exemptions from the Trump administration’s threat of drug tariffs.
