| It’s no longer just the pharma giants; smaller drug companies want in the MFN game, too. The Trump administration on Monday rolled out nine more drug-pricing agreements to voluntarily lower medicine prices in line with what peer countries pay, known as most-favored-nation, or MFN, pricing. It adds to the 17 deals other companies — including Pfizer, AstraZeneca, Merck, Eli Lilly and Novo Nordisk — cut with the administration last year. President Donald Trump held a briefing in the Oval Office surrounded by senior health officials and the chief executives of the companies involved: Alcon, Astellas Pharma, BeOne Medicines, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva Pharmaceuticals and UCB. “We now have 26 companies representing 90 percent of the domestic pharmaceutical market, and the other 10 percent are also coming in [to make deals],” Trump said during the announcement. “They have no choice.” Much like the agreements larger pharmaceutical companies made, there aren’t many details surrounding the new deals. As part of the agreement, the companies are lowering prices on products that treat conditions including hemophilia, Parkinson’s disease, glaucoma, liver disease, and various forms of cancer — and offering MFN pricing to state Medicaid programs. Several companies — including Astellas Pharma, Sun Pharma, Teva Pharmaceuticals and UCB — will donate massive quantities of their products to the Strategic Active Pharmaceutical Ingredients Reserve, in order to “reduce reliance on foreign nations and ensure the United States has an adequate supply of such products in the event of an emergency,” according to the White House. In return, those who’ve come to the table get a reprieve from tariffs and other benefits. Although there have been several rounds of White House announcements involving pharmaceutical executives praising the administration’s drug-pricing efforts, the broader industry — represented by the Pharmaceutical Research and Manufacturers of America (PhRMA) — remains nonplussed about the whole thing. PhRMA, which counts many of the dealmakers as members, objects to the move to tie U.S. prices to those abroad, calling the policies government-imposed price controls. The group argues it would “undermine U.S. competitiveness.” “Today’s announcement reflects companies making their own individual pricing decisions based on their unique circumstances and patient populations,” said Alex Schriver, senior vice president of public affairs at PhRMA. “Private agreements are fundamentally different from government-mandated price-setting.” The Trump administration has also been pushing lawmakers on Capitol Hill to codify the principles of the deals. While none of those efforts has gained traction with skeptical Republicans, some Democratic lawmakers have appeared eager to pick up the drug-pricing baton if they regain control of one or both chambers of Congress after the midterms. WHAT’S NEXT More deals: As Trump mentioned, there are still other companies the administration has in its sights — including a few that reportedly had been ready to make a deal but remained absent from the Oval Office announcement. So it’s worth watching to see whether more pharma industry players come forward. More models: The Trump administration has proposed two mandatory pilot programs to offer MFN pricing for products in Medicare Part B and Medicare Part D. The final versions of the proposals, which received pushback and legal threats, are now sitting at the White House for review. The Global Benchmark for Efficient Drug Pricing (GLOBE) model — for drugs in Medicare Part B — is scheduled to launch at the beginning of October, which means it needs to be rolled out soon. Any implementation delay needs to be telegraphed in the next few weeks. But the big question is: If the MFN deals announced by the administration comprise roughly 90 percent of the drug spend in the United States — and the companies that cut those deals are all likely exempt from the upcoming mandatory models — how big of an impact will these pilots even have? The Trump administration’s emphasis on a system of “trade over aid” as it revamps U.S. foreign-aid programs could result in billions of dollars in cuts over the next several years, despite Congress directing this funding to remain relatively flat, according to a new report from nonprofits Public Citizen and Partners in Health. My colleague in The Post’s newsroom Adam Taylor has been following the administration’s new approach to foreign aid and has all the details of the analysis. The State Department has drawn up agreements with 34 countries, and the report breaks down 18 where figures have become available. - The planned cuts to U.S. foreign aid appear to reduce funding for various countries by 43 percent and 95 percent from 2024 levels by 2030, according to the analysis. The programs getting hit include ones aiming to counter deadly diseases including HIV/AIDS, Ebola and tuberculosis.
- The steepest projected funding reductions were in Rwanda (97 percent), Liberia (84 percent), Burundi (78 percent), Madagascar (77 percent) and Sierra Leone (71 percent), according to the analysis.
- These agreements, Adam points out, often include clauses that countries receiving diminished U.S. health funding must at the same time increase their own spending. The State Department told The Post that the deals reached so far amounted to $14.5 billion in new U.S. assistance, alongside more than $10.1 billion in “co-investment” from recipient countries.
Public Citizen and Partners in Health have raised doubts about how practical the deals are, highlighting that the agreements have penalties for noncompliance — including a further cut of U.S. funding help. “Sierra Leone is supposed to make up a 71 percent U.S. funding drop in less than five years,” said Peter Maybarduk of Public Citizen. “It’s going to be very difficult, and if a country like that falls behind, and then is punished for that, then of course the health problems compound.” Read the full story: “Secretive deals may cut billions from U.S. global health spending, analysis shows.” 7.6 percent That’s the share of patients choosing to pay cash for emergency department visits during the second quarter of this year, according to the latest study from Epic Research, division of the electronic medical records company. It’s a more than 2 percentage point increase from early 2022, tracking alongside the decline in people with Medicaid. The analysis, shared first with Health Brief, evaluated more than 550 million U.S. health care encounters. Why it matters: The trendline offers a glimpse of how the loss of Medicaid coverage may be showing up in patients’ bills, which could be a key sticking point as the focus on affordability increases. Starting in 2023, states began unwinding a pandemic-era policy that had temporarily boosted Medicaid enrollment. More than 25 million people lost health coverage as a result. → While the uptick in self-pay encounters rose the most in emergency rooms, there was also an uptick in patients paying cash across every type of health care setting studied by the analysis: emergency, inpatient, birth and primary care. Conversely, patients utilizing Medicaid to pay for emergency room visits decreased from 18.2 percent in 2022 to 16.1 percent by June 2026 — and there were Medicaid declines in every other health care setting studied. | 
