Darwin's Our Take: Another 9 drugmakers agree to most-favored-nation pricing on certain products

The White House announced that nine additional pharmaceutical companies have agreed to align U.S. drug prices with those paid in other developed countries.

The latest participants include:

• Amgen
• Boehringer Ingelheim
• Bristol Myers Squibb
• Gilead Sciences
• GSK
• Merck
• Novartis
• Genentech (Roche subsidiary)
• Sanofi

They join AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer, which signed earlier agreements.

In exchange for lowering prices on select medications, manufacturers will avoid regulatory actions that could harm profits, including receiving a three-year exemption from potential pharmaceutical tariffs.

How Patients Access the Lower Prices

Patients will access lower prices through programs that bypass insurance plans and formularies, including direct-buy programs from manufacturers.

The federal government will launch TrumpRx in January to direct patients to these programs.

Key Agreement Terms

• Drugmakers guarantee most-favored-nation (MFN) pricing on all new innovative U.S. medicines
• All Medicaid programs will receive MFN pricing
• Companies committed at least $150 billion in near-term U.S. manufacturing investments
• Several will donate to the Strategic Active Pharmaceutical Ingredients Reserve

Of the 17 drugmakers contacted by the White House, only AbbVie, Johnson & Johnson, and Regeneron have not yet signed agreements, though negotiations are ongoing.

CMS Proposes New International Pricing Models

CMS proposed two mandatory Medicare pricing models:

GUARD Model (Part D)

• Assesses manufacturer rebates if prices exceed international benchmarks
• Mandatory
• Five-year period starting Jan. 1, 2027

GLOBE Model (Part B)

• Similar rebate structure tied to international benchmarks
• Mandatory
• Five-year period starting Oct. 1, 2026

Public comments are due by Feb. 23, 2026.

Our Take

While the administration highlights projected savings, uninsured patients may benefit most. Insured patients may still pay less using traditional insurance channels than buying directly from manufacturers.

Many drugs in the MFN agreements face patent expiration, meaning price reductions were likely coming regardless.

Medicaid already receives the lowest U.S. prices by law, often comparable to European pricing.

Manufacturing investment pledges were largely made earlier in 2025 to avoid tariffs that never materialized.

Health Care Rounds #196: Dr. Sowmya Viswanathan

Dr. Sowmya Viswanathan, Chief Physician Executive at BayCare Health System, discusses:

• Physician burnout and workforce shortages
• AI and technology restoring joy in practice
• BayCare’s academic medicine strategy
• Flexible physician alignment models

Watch or listen wherever you get your podcasts.

What Else You Need to Know

Cencora Acquires OneOncology

Cencora will pay $5B for a majority stake in OneOncology, including $3.6B to purchase remaining shares and retiring $1.3B in debt. The deal is expected to close in Q1 2026.

BioMarin Acquires Amicus

BioMarin will acquire Amicus Therapeutics for $4.8B, adding Fabry and Pompe disease treatments and rights to Phase III kidney disease candidate DMX-200.

New Obesity Drug Filings

• Lilly filed for FDA approval of orforglipron (oral GLP-1)
• Novo filed for CagriSema, a GLP-1/amylin injectable combination

Because of Lilly’s priority voucher, orforglipron may receive an FDA decision within weeks.

Optum Rx Pharmacy Model

All community pharmacies in Optum Rx’s network transitioned to a cost-based reimbursement model. Three additional pharmacy organizations representing 17,000 pharmacies joined the program.

CMS LEAD ACO Model

CMS introduced the LEAD ACO model launching in 2027 with:

• 10-year duration
• Fixed benchmarks for predictability
• Dual risk tracks (global and professional)
• Focus on high-need and dual-eligible patients
• Rural provider incentives
• Episode-based specialist risk

Applications begin March 2026.

ChristianaCare and Virtua End Merger Talks

ChristianaCare and Virtua Health terminated merger discussions, choosing to remain independent.

What We’re Reading

• The 25th Anniversary of a Nearly Unknown Health Policy Turning Point — NEJM
• Critical Access Pharmacy Designations Could Strengthen Access — Health Affairs
• Trends and Prevalence of Metabolic Syndrome Among U.S. Adults — JAMA

‍

‍