How BioPharma Is Reacting to MFN: Real Moves, Real Strategy

PharmaTell
2 days ago
4 min read

Over the past year, the concept of “most-favored nation” (MFN) drug pricing has shifted from policy debate to corporate strategy — and the response from the industry is already shaping up in layers. What began as an executive-order directive is now influencing the global launch plans, pricing mechanics, contract models, and patient-access strategy of both large pharmaceutical firms and smaller biotechs. Following-up on our last post about MFN Pricing, below is a refreshed view of how the industry is reacting — and what it means for companies, patients and investors.

1. From Theory to Deal: Big Pharma Embraces MFN-style Commitments

Pfizer became the first major pharma company to publicly strike an MFN-style agreement under the 2025 Most-Favored-Nation Prescription Drug Pricing initiative. On September 30, 2025, Pfizer agreed to offer many of its medicines to U.S. patients — including through Medicaid — at prices comparable to those in other developed nations, and to price future launches on parity with international markets.
As part of the deal, Pfizer committed to participate in a new direct-to-consumer sales platform — TrumpRx.gov — offering substantial discounts (average 50%, up to ~85%) on select therapies for eligible patients. Pfizer+2Reuters+2
Not long after, AstraZeneca followed suit. On October 10, 2025, it announced an agreement with the U.S. government committing to MFN-equivalent pricing for state Medicaid programs, discounted direct-to-consumer drug access, and a multi-billion-dollar investment plan (roughly $50 billion through 2030) to expand U.S.-based manufacturing and R&D.
These public deals underscore how MFN is no longer just a regulatory risk — it is being operationalized by major players as part of a broader commercial strategy.

2. The Strategic Playbook: What MFN-Navigating Firms Are Doing Now

The broad moves by Pfizer, AstraZeneca and a handful of peers validate many of the strategies being used across the industry. Companies are now acting on multiple fronts:

Pricing & Contract Redesign — Reworking list vs. net price structures, rebate mechanics, and launch-contract terms to avoid unintended MFN triggers and preserve global price flexibility.
Launch Sequencing & International Strategy — Recognizing that global reference or “lowest international price” benchmarks now affect U.S. prices, firms are being more deliberate about where and when to launch new products. Delayed launches or staggered rollouts in lower-price markets are increasingly common.
Selective Deals & Value-Based Models — Instead of blanket discounts, many firms opt for targeted commercial agreements or outcomes-based contracts that preserve headline list prices while offering flexibility at the net/real-world level. This is especially relevant for specialty or high-cost therapies.
Direct-to-Consumer Channels — With platforms like TrumpRx.com launching in 2026, major companies are embracing DTC as a complementary channel to traditional payers. This helps them offer steep cash-price discounts to uninsured or underinsured patients while containing rebate obligations and net-price pressure on contracted payers.
Governance & Compliance Infrastructure — Legal, pricing, market-access, and finance teams are increasingly collaborating to ensure documentation, rebate tracking, transfer-pricing, negotiation reporting and forecasting are robust. This strengthens the companies’ ability to manage exposure under MFN / international reference pricing (IRP) regimes.
Policy Engagement & Public Positioning — As some firms make public MFN commitments, others remain cautious. Executives and industry-wide trade groups continue to emphasize that MFN alone doesn’t resolve structural issues like middle-man dynamics, access disparities, or global price distortions — making proactive policy engagement vital.

3. Smaller Biotechs and Emerging Firms?

Not all parts of the industry are reacting the same. For smaller biotechs and emerging firms, the dynamic is different:

Because they often lack the global scale, existing portfolios, or manufacturing breadth of “big pharma,” many are cautious — reassessing U.S. entry strategies, launch sequencing, and investor communication plans, rather than committing to broad MFN-style deals.
Instead, they may opt for partnerships with larger commercial players, value-based / outcomes-driven licensing agreements, or selective efforts to preserve list prices while offering affordability programs.
Some may delay U.S. launches, prioritize non-U.S. markets, or explore alternative commercialization models (e.g. limited distribution, specialty/indication-specific contracting) to avoid unintended MFN-related downstream effects.

This more conservative, flexible posture reflects both risk management and strategic adaptability — a contrast to the public commitments forged by legacy global players.

4. Key Takeaways & Strategic Imperatives

MFN is now a strategic variable, not just a compliance constraint. Firms treating it as a box-checking exercise risk either undercutting margins or harming global pricing flexibility. The winners treat MFN as a factor shaping portfolio decisions, launch timing, contracting strategy, and patient access design.
Direct-to-consumer models are gaining strength. Platforms like TrumpRx.gov (2026 launch) are proving that DTC delivery and pricing can be part of a broader strategy to balance price controls, access, and payer dynamics.
Governance, data and compliance frameworks are more important than ever. As firms juggle contracting complexity, forecast volatility, and global price spill-over risk, robust internal infrastructure — legal, finance, market access — becomes essential.
Smaller biotechs must be more nimble. Without the leverage of legacy players, emerging firms will likely lean on flexibility: selective deals, strategic partnerships, and staged rollouts — not headline-price commitments.
Policy engagement remains critical. As MFN and IRP reshape drug pricing globally, companies benefiting from or affected by policy shifts must engage proactively.

We are witnessing a pivot point in how the pharmaceutical industry operates: MFN — once a policy abstraction — is now reshaping corporate strategy, pricing frameworks, and commercialization models. From the public commitments of giants like Pfizer and AstraZeneca, to the cautious adaptability of emerging biotechs, the “new normal” in pharma is one of layered strategy, cross-functional planning, and agile execution.

At PharmaTell, we will continue to monitor developments closely — MFN deals, regulatory-policy shifts, and commercial rollouts — and update you via the Eyes On Pharma Blog and LinkedIn.

This post references publicly available sources such as US Government, CMS, Corporate Press Releases, Industry News Letters, Global news sources, Healthcare Sector websites and white papers.