PhRMA pushes back on MFN policy

The fight is over a White House plan to make Americans pay no more for some drugs than patients in other wealthy countries. (whitehouse.gov) President Donald Trump signed the executive order on May 12, 2025. It said U.S. patients should get a “most-favored-nation” price and directed the administration to pressure manufacturers if they did not comply. (whitehouse.gov 1) (whitehouse.gov 2) The White House said Americans pay more than three times what other OECD countries pay for brand-name drugs after discounts. It also said Health and Human Services would create a way for patients to buy some medicines directly from manufacturers. (whitehouse.gov) Pharmaceutical Research and Manufacturers of America answered the same day. Chief executive Stephen J. Ubl said foreign governments should “pay their fair share,” but said importing foreign prices would mean fewer treatments and cures. (phrma.org) PhRMA also argued that pharmacy benefit managers, insurers and hospitals take 50% of every dollar spent on medicines in the U.S. The group said those middlemen, not list prices alone, are a central reason patients pay more. (phrma.org) The Healthcare Distribution Alliance focused on the supply chain. It said distributors save the health system about $63 billion a year, deliver 10 million medicines a day, and connect 1,200 manufacturers to 330,000 providers, pharmacies and care sites. (hda.org) HDA said the order’s direct-to-consumer and importation provisions could hurt access for providers and patients and weaken long-term supply-chain stability. It said distributors operate on 0.3% margins and asked the White House to preserve an efficient and secure distribution system. (hda.org) The Biotechnology Innovation Organization made a similar case later in 2025. Chief executive John F. Crowley said MFN would not lower most patients’ out-of-pocket costs and could hit small and midsize biotech companies that discover more than half of new treatments. (bio.org) The administration moved from broad threats to concrete targets on May 20, 2025. Health and Human Services said manufacturers were expected to align U.S. prices for brand drugs without generic or biosimilar competition to the lowest price in certain OECD countries. (hhs.gov) By April 23, 2026, the White House said it had reached its 17th MFN agreement, this time with Regeneron. The administration said those deals covered 17 leading manufacturers representing 86% of the branded drug market. (whitehouse.gov) That same White House fact sheet said Regeneron would cut the direct-purchase price of Praluent to $225 from $537 through TrumpRx. It also said Regeneron would invest $27 billion in U.S. research, development and manufacturing by 2029. (whitehouse.gov) So the dispute has settled into two tracks: the administration says foreign reference pricing can force lower prices, while drugmakers and distributors say the policy shifts pressure onto research, contracting and delivery. The next test is whether those manufacturer deals produce durable lower prices without breaking the channels that move medicines to hospitals, pharmacies and clinics. (whitehouse.gov) (phrma.org) (hda.org)