Medicaid access to Most Favored Nation through the Pfizer agreement: The unanswered issues

In the following commentary, we discuss the motivation for the Trump-Pfizer Most Favored Nation (MFN) pricing deal, a preliminary analysis on potential savings, and discussion on the details that will determine the success of the Trump-Pfizer deal. This deal represents the Trump administration's pursued health policy to get Americans a "better deal" for drug pricing by providing Medicaid programs access to MFN pricing for Pfizer-branded drugs. Using different data sources, we provide a preliminary analysis on the deal's impact on 6 Pfizer drugs. Our results suggest Medicaid programs may save a maximum of $280 million from access to MFN pricing, reflecting 11.5% in additional rebates off gross spending. Medicaid programs will have greater potential net savings when using MFN benchmarking for newer drugs with lower baseline rebates compared with older, highly rebated drugs. It is uncertain if the MFN prices will apply to all new and existing Pfizer drugs or just a selection. We also highlight several implementation challenges ranging from different marketed names of drugs to selection of countries for MFN pricing that will influence the deal's impact.