Repricing fairly: balancing MFN and domestic reforms

US prescription drug costs remain the highest globally, prompting proposals such as the most favored nation (MFN) pricing model, which benchmarks US drug prices to those of peer nations. In contrast, domestic market-based reforms focus on internal negotiation, competition, and transparency. Although MFN promises rapid cost reductions, it risks innovation disincentives and access delays. This commentary argues for a hybrid policy approach that combines the efficiency of MFN with domestic reforms, guided by equity-focused valuation frameworks such as Generalized Risk-Adjusted Cost-Effectiveness and severity-adjusted willingness-to-pay. A balanced model can achieve affordability without undermining innovation or equity.