Most Favored Nation Drug Pricing

February 4, 2026

Key Findings

Half of survey respondents felt that most favored nation (MFN) drug pricing — a policy linking the prices of prescription drug prices in the U.S. to those paid in peer countries — would substantially reduce average net prices for branded drugs in the U.S. Another quarter were uncertain about the policy’s impact on prices. A number of respondents raised concerns about the feasibility of implementing MFN pricing and responses of manufacturers that could make such a policy less effective.
Most respondents did not feel that MFN pricing would substantially improve access to branded prescription drugs for patients with public or private forms of insurance, although there was considerable uncertainty. Several panelists noted that Medicaid programs already pay relatively low prices for branded drugs and that MFN prices may still be too high for uninsured individuals.
Panelists were mixed on whether MFN pricing would substantially reduce pharmaceutical innovation benefiting patients in the U.S. Thirty-eight percent agreed or strongly agreed that such a policy would reduce innovation, 28% disagreed or strongly disagreed, and 32% were uncertain. Several panelists suggested that the policy could lead to some decline in innovation, but that the impact depends on the magnitude of the decline in revenues for pharmaceutical companies, which itself is an uncertain outcome.

Read the full Health Affairs Forefront summary of results here

Survey Questions

Please note: our surveys will consistently use two modifiers to describe the size of an effect: “Substantial”: when an effect is large enough to meaningfully influence policy decisions, program implementation, or outcomes of interest “Measurable”: when the direction of an effect is clear, but the effect may not be sufficiently large to make much of a difference for a given policy, program, or outcome.

Response rate of 97% (60 out of 62 panelists responded, 1 panelist abstained)

The Trump Administration has expressed a desire to link US prescription drug prices to net prices paid in peer countries, a policy known as Most Favored Nation (MFN) drug pricing. An MFN pricing policy would require manufacturers of branded drugs to charge any payer or patient a price equal to or lower than the MFN price. This price would be defined as the second lowest manufacturer-reported net price (adjusted for Gross Domestic Product per capita) in peer countries.

Question 1: MFN pricing would substantially reduce average net prices for branded prescription drugs in the US.

a. Strongly Agree
b. Agree
c. Uncertain
d. Disagree
e. Strongly Disagree
f. No Opinion

Question 2: MFN pricing would substantially improve access to branded prescription drugs for the following patient populations in the US (select all that apply)

a. Uninsured
b. Commercially insured
c. Medicare
d. Medicaid
e. None of the above
f. Uncertain

Question 3: MFN pricing would substantially reduce pharmaceutical innovation benefiting US patients.

a. Strongly Agree
b. Agree
c. Uncertain
d. Disagree
e. Strongly Disagree
f. No Opinion

Individual Survey Responses

Question One

MFN pricing would substantially reduce average net prices for branded prescription drugs in the US.

Name	Vote	Confidence	Comments
Margarita Alegria	Uncertain	5
David Asch	Agree	6
John Ayanian	Agree	5
Peter Bach	Disagree	7	The implementation of this program is nearly impossible.
Laurence Baker	Agree	7
David Blumenthal	Strongly Agree	7
Erin Fuse Brown	Uncertain	6	The MFN pricing methodology would be gameable by drug company rebates. Furthermore, legal challenges may slow or block implementation.
Melinda Buntin	Uncertain	6
Michael F. Cannon	Agree	2
Lawrence Casalino	Agree	6
Amitabh Chandra	Strongly disagree	10
Lanhee J. Chen	Disagree	7
Michael Chernew	Agree	5
Janet Currie	Agree	6
Lesley Curtis	Disagree	8	I expect manufacturers to respond by increasing prices outside of the US. Potential for short-term decrease but not long term.
David Cutler	Agree	6	I wonder what types of games companies may play — e.g., having different drugs in different countries.
Julie Donohue	Uncertain	6	It is not clear the administration has the legal authority to impose this absent legislation. Pharmaceutical manufacturers could respond to such a policy by raising prices elsewhere in the world.
Joseph Doyle	Agree	7
David Dranove	Disagree	9	PBMs already achieve significant discounts. Any further discounts would be small.
Stacie Dusetzina	Strongly disagree	9	Based on carve outs already made to most drug companies, very few branded drug products would be eligible for MFN prices. Current implementation focuses on Medicaid in those voluntary agreements and pricing is likely to be similar to MFN prices in that program. Even if there were not many loopholes, access to international reference prices has remained a problem with MFN like pricing agreements.
Jose Esarce	Did not answer
Elliott Fisher	No opinion	0
Richard Frank	Agree	7
Craig Garthwaite	Uncertain	10	The real problem with any MFN policy for the United States will be the details and therefore it is really hard to figure out what the impact would be. The range of proposed MFN policies have ranged from entirely ineffective to quite stringent, and I’m not sure which of these we would be thinking about for such a question.
Darrell Gaskin	Agree	7
Martin Gaynor	Disagree	7	Such an MFN requirement will almost certainly cause pharmaceutical prices outside the US to increase. It may lead to US prices declining somewhat, but given the size and importance of the US market pharma companies may reduce prices in the US little or not at all.
Sherry Glied	Agree	5
David Grabowski	Strongly Agree	8
Jonathan Gruber	Uncertain	5
Vivian Ho	Strongly Agree	6	Branded drug companies are likely making significant profits on the lower prices they are charging in other countries. Given that, they ought to be willing to lower their prices in the U.S. if forced to do so. However, I wouldn’t put it beyond these companies to restrict supply of important medications, in an effort to force the U.S. to change policies.
Jason Hockenberry	Agree	7
Haiden Huskamp	Disagree	7
Benedic Ippolito	Uncertain	10	The U.S. market is at least 10-20 times larger than markets in reference countries in current MFN proposals (and larger than all combined). Firms will have a huge incentive to circumvent the policy, delay launches/increase prices in reference countries, making the effects uncertain.
Anupam Jena	Abstained
Nancy Keating	Uncertain	5
Aaron Kesselheim	Strongly Agree	7	Certainly initially, but my confidence is diminished because the pharmaceutical industry will strategically respond to blunt the effect, which is why in contrast to MFN pricing, the right policy is broader US price negotiation.
Jonathan Kolstad	Disagree	6
R Tamara Konetzka	Uncertain	7	I’m fairly confident that the outcome is uncertain! It may reduce some prices, but there are a lot of ways that drug manufacturers may get around this issue or ensure the prices are not transparent (e.g. raising prices but offering rebates)
Rick Kronick	Strongly Agree	7
Valerie Lewis	Did not answer
Nicole Maestas	Agree	8
Tom McGuire	Disagree	6
Ellen Meara	Agree	7	Since we cannot see rebates, i’m less confident about the magnitude of price drops, but they surely would be lower.
Ateev Mehrotra	Agree	9
David Meltzer	Strongly Agree	9
Joseph Newhouse	Strongly Agree	8
Sean Nicholson	Strongly Agree	9	My response assumes that the policy passes (Congress) as described above and applies to all drugs. By executive order or bully pulpit, the effect would likely occur only on a small subset of drugs and have a negligible effect on overall spending.
Steve Parente	Agree	8
Stephen Patrick	Uncertain	5
Harold Pollack	Uncertain	4	This is an ambitious experiment, with likely good and bad unanticipated consequences for patients, payers, drug manyufacturers, and patients around the world. I am concerned about consequences for patients in low-income nations, who require life-saving drugs.
Daniel Polsky	Agree	6
Ninez Ponce	Disagree	7	Hard to assess since plan that the public can evaluate is vague.
Thomas Rice	Agree	6
Meredith Rosenthal	Agree	8	This plan seems so infeasible I have trouble scoring it. I am certain that our brand name drug prices are the highest in the world so if we literally started paying the lowest prices it would have a big effect. And so it cannot possibly happen…maybe for a few products for a political win.
Joseph Ross	Disagree	7	While there may be measurable price decreases, they will not be substantial, and I think it is more likely that companies will use MFN as a pretense for raising prices in peer countries.
Brendan Saloner	Disagree	5
Kosali Simon	Agree	5
Jon Skinner	Uncertain	6
Ben Sommers	Uncertain	5	the question is whether it would more benefit companies to cut their prices here or raise prices elsewhere
Neeraj Sood	Uncertain	5	I think firms can game the system by having high list prices in other countries and offering confidential rebates or discounts.
David Stevenson	Disagree	4
Kevin Volpp	Strongly Agree	10
Rachel Werner	Uncertain	5

Question Two

MFN pricing would substantially improve access to branded prescription drugs for the following patient populations in the US (select all that apply)

Name	Vote	Confidence	Comments
Margarita Alegria	None of the above	6
David Asch	Commercially insured, Medicaid, Medicare, Uninsured	6
John Ayanian	Uninsured	3
Peter Bach	None of the above	8	Implementation challenges and the policy as I understand it does not affect copayments which are the access challenge.
Laurence Baker	None of the above	7
David Blumenthal	Uninsured	6
Erin Fuse Brown	Uncertain	0
Melinda Buntin	Commercially insured	4
Michael F. Cannon	Uninsured	2
Lawrence Casalino	Commercially insured, Medicare	4
Amitabh Chandra	None of the above	7	It is possible that MFN pricing could lower the out-of-pocket price that patients pay, and this would mostly affect the uninsured period. This part of it makes a lot of sense.
Lanhee J. Chen	None of the above	5
Michael Chernew	Commercially insured, Medicare, Uninsured	5	Depends how its implemented and how purchasers respond
Janet Currie	Commercially insured, Medicaid, Medicare, Uninsured	6
Lesley Curtis	Medicaid, Medicare	8
David Cutler	Commercially insured, Uninsured	5
Julie Donohue	Uncertain	0	The impact of the policy is uncertain because the legality of a policy unilaterally adopted by the executive branch is uncertain.
Joseph Doyle	None of the above	5	The US already has by far the best access to medications, earlier than other countries due to the high price. Lower prices would increase access via health insurance, but it would have to be filtered through more generous drug coverage and there are few links in that chain.
David Dranove	Uninsured	9
Stacie Dusetzina	None of the above	9	The only program in which most companies are expected to offer MFN pricing due to the voluntary agreements is in Medicaid. Unclear if prices will be reduced under MFN for that program and patients are shielded from the price in that program.
Jose Esarce	Did not answer
Elliott Fisher	Uncertain	0
Richard Frank	Uncertain	0	How MFN affects out of pocket costs depends importantly on how it is implemented.
Craig Garthwaite	None of the above	6	If we think about MFN pricing as being an effective policy that lowers the domestic price to some degree, then we are really thinking here, do we think that there is a large decrease in access from higher net prices. I have not seen meaningful evidence that this is the case – nor am I convinced that we would see meaningful changes to cost sharing.
Darrell Gaskin	Uncertain	0	I depends on whether the payer or the patient receives the benefit of the price reductions.
Martin Gaynor	None of the above	8	I don’t expect a large decrease in US prices of branded pharmaceuticals, so I don’t expect increased access.
Sherry Glied	None of the above	8
David Grabowski	Commercially insured, Medicaid, Medicare	8
Jonathan Gruber	Medicaid, Medicare, Uninsured	7
Vivian Ho	Uncertain	0	Given time, drug companies would respond by raising prices of drugs worldwide. I don’t have the data or knowledge to predict which drugs would be affected the most.
Jason Hockenberry	Medicaid, Medicare, Uninsured	5
Haiden Huskamp	None of the above	7
Benedic Ippolito	Uncertain	0	If a policy did materially change prices, the effects would be concentrated in Medicare and commercial. But price change is highly uncertain.
Anupam Jena	Abstained
Nancy Keating	Uncertain	0	It depends what “access to branded drugs” means? it may lower costs of existing drugs, but might also lead to less innovation and fewer branded drugs developed.
Aaron Kesselheim	Commercially insured, Medicare	6	It’s likely that initially lower prices would facilitate broader coverage of at least some brand-name drugs (ideally the ones with meaningful benefits for patients), but I’d feel more “confident” about that if anything similar to MFN pricing would be linked to requirements for such coverage.
Jonathan Kolstad	None of the above	5
R Tamara Konetzka	Commercially insured	3	Unlikely to affect Medicaid because prices are often lower already; unlikely to affect Medicare access after IRA changes because OOP costs already capped; prices may still be too high to affect access for uninsured.
Rick Kronick	Uninsured	6
Valerie Lewis	Did not answer
Nicole Maestas	Commercially insured, Medicaid, Medicare, Uninsured	7
Tom McGuire	None of the above	7
Ellen Meara	Uncertain	0	Since we don’t see rebates among insured groups and even a reduced price may be out of reach for many uninsured patients, I’m uncertain of the access change.
Ateev Mehrotra	Medicaid, Uninsured	9
David Meltzer	Commercially insured, Medicaid, Medicare	8
Joseph Newhouse	None of the above	6	Price may still be too high for the uninsured. Most gains will accrue to payers.
Sean Nicholson	Uninsured	8
Steve Parente	Commercially insured, Medicare, Uninsured	7
Stephen Patrick	Uncertain	0
Harold Pollack	Medicaid, Medicare	3
Daniel Polsky	None of the above	7	Price reductions may have a greater impact on the cost of insurance than on access to drugs. And prices still unaffordable for uninsured.
Ninez Ponce	Uncertain	0
Thomas Rice	Commercially insured, Medicare, Uninsured	6
Meredith Rosenthal	Medicaid, Uninsured	6	For the uninsured, these lower prices could make a difference — not for the poorest of this group but at the higher end. In Medicaid there would be some products that are off formulary now but could be covered if prices were much lower.
Joseph Ross	None of the above	9	I think that with MFN, drug prices are likely to remain high and out-of-pocket costs will remain approximately the same for insured individuals. Lost from the discussion thus far is that many high-cost drugs are not considered beneficial enough for peer nations to provide coverage, so if there is no “peer price”, there is no MFN price for the U.S. (and we will continue to pay wholly unjustified high prices).
Brendan Saloner	Uninsured	5
Kosali Simon	Commercially insured	6
Jon Skinner	Uncertain	0
Ben Sommers	Uncertain	0
Neeraj Sood	Uncertain	0	Same reason, firms could game the system thus not affecting prices in the US but increasing list prices in other countries.
David Stevenson	None of the above	4
Kevin Volpp	Commercially insured, Medicaid, Medicare	9
Rachel Werner	Uncertain	0

Question Three

MFN pricing would substantially reduce pharmaceutical innovation benefiting US patients.

Name	Vote	Confidence	Comments
Margarita Alegria	Strongly disagree	8
David Asch	Agree	6
John Ayanian	Uncertain	3
Peter Bach	Disagree	7
Laurence Baker	Disagree	5
David Blumenthal	Disagree	5
Erin Fuse Brown	Agree	6
Melinda Buntin	Disagree	6	Substantially is a strong term – it would, but perhaps not substantially
Michael F. Cannon	Uncertain	6
Lawrence Casalino	Uncertain	6
Amitabh Chandra	Agree	7
Lanhee J. Chen	Agree	8
Michael Chernew	Agree	5
Janet Currie	Uncertain	5
Lesley Curtis	Agree	8
David Cutler	Disagree	5
Julie Donohue	Uncertain	6	Same as above
Joseph Doyle	Agree	4	This is a crucial parameter and there is considerable uncertainty around it.
David Dranove	Disagree	9	If the pricing impact is small, the research impact will be small
Stacie Dusetzina	Disagree	7	If operationalized broadly (not in the way that it is presumably going to be operationalized), it could have some impact on drug innovation. Ideally, however, prices in the US would be more aligned with value and it could improve the investments in higher value (rather than lower value drugs).
Jose Esarce	Did not answer
Elliott Fisher	No opinion	0	I wish I had sufficient knowledge of this topic to be able to give useful responses
Richard Frank	Uncertain	3	Again, it depends on how the MFN prices are used. If a multiplier to MFN is used (like in HR 3), it would have less dramatic revenue impacts than a straight application of say a lowest international reference price among wealthy OECD countries.
Craig Garthwaite	Agree	7	Again, I am assuming we are talking about a policy that lowers revenues here (which we don’t know would happen from an MFN). I would also quibble a bit here with the framing of “US patients,” as it would reduce innovation that would otherwise be a benefit for all patients.
Darrell Gaskin	Disagree	7	Current pricing encourages and rewards modest innovations.
Martin Gaynor	Uncertain	6	If pharma companies’ expected profits from new drugs falls substantially under the MFN policy, then I’d expect to see less innovation, but it’s very unclear if their profits will fall so much that innovation becomes much less profitable.
Sherry Glied	Agree	5
David Grabowski	Strongly Agree	9
Jonathan Gruber	Uncertain	10	Depends on how the revenues are spent – in a vacuum it will lower innovation but if the revenues are used for NIH innovation will go up.
Vivian Ho	Uncertain	10	There should still be substantial returns to development of novel medications that improve patient health more than existing alternatives.
Jason Hockenberry	Agree	7
Haiden Huskamp	Agree	7
Benedic Ippolito	Uncertain	3	The relationship between revenues and investments is clear, but the effect on net revenues is too unclear.
Anupam Jena	Abstained
Nancy Keating	Agree	5
Aaron Kesselheim	Strongly disagree	10
Jonathan Kolstad	Strongly Agree	9
R Tamara Konetzka	Disagree	5	Incentives for innovation are important but current prices could likely come down substantially without large reduction in innovation. (Would prefer other support for innovation such as direct support of research rather than excessive prices.)
Rick Kronick	Uncertain	4
Valerie Lewis	Did not answer
Nicole Maestas	Agree	10
Tom McGuire	Disagree	7
Ellen Meara	Agree	5	Losing out on the upper tail pricing of branded drugs in US markets will discourage innovation with certainty. The magnitude is less clear.
Ateev Mehrotra	Agree	7
David Meltzer	Uncertain	7
Joseph Newhouse	Agree	8	High value drugs will still be brought to market as will losers in an innovation race but there will be some reduction.
Sean Nicholson	Strongly Agree	9
Steve Parente	Uncertain	7
Stephen Patrick	Agree	7
Harold Pollack	Uncertain	3
Daniel Polsky	Disagree	5	It may end up rewarding innovation in areas that need innovation rather than areas where pricing is most profitable. The direct evidence on this question is not that strong.
Ninez Ponce	Uncertain	8
Thomas Rice	Uncertain	7
Meredith Rosenthal	Uncertain	5	This is so hard to say. It would surely reduce innovation by some amount. But whether that is substantial or not is less certain. And also it would reduce some “innovation” that is welfare reducing — new line extensions with little benefit that keep spending high.
Joseph Ross	Strongly disagree	8	I do not think MFN pricing will substantially affect pharmaceutical company revenue, nor their R&D investments.
Brendan Saloner	Disagree	7
Kosali Simon	Agree	6
Jon Skinner	Uncertain	1
Ben Sommers	Uncertain	5
Neeraj Sood	Agree	5	I think this affects innovation as it creates a chilling effect that pharma price regulation is happening and even if this policy is not binding other policies might be binding.
David Stevenson	Disagree	4
Kevin Volpp	Agree	8
Rachel Werner	Disagree	7

Meet our panel of experts

Cornell Health Policy Center

Cornell Health Policy Center

Most Favored Nation Drug Pricing

Key Findings

Survey Questions

Individual Survey Responses

Question One

Question Two

Question Three

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