MFN, Its Global Ripple Effects, and the Role of HTA in the US
US pharmaceutical policy choices continue to shape global markets, often with unintended domestic and international consequences. Our analysis of the Trump Administration’s MFN executive order - signed in May 2025 and now being implemented through a series of voluntary manufacturer agreements - shows how even incremental US policy changes can have wide-reaching effects. MFN is reshaping R&D incentives, altering launch sequencing, and affecting patient access in both the US and Europe.
Europe's experience highlights that pharmaceutical pricing policies involve trade-offs. Its approach reflects underlying societal preferences and priorities, as all policy choices do. Linking US prices to those in Europe through MFN implicitly imports European value judgements - choices that may not align with US priorities and risk distorting global pharmaceutical markets, innovation, investment, and industry structure. And while its implementation advances, these dynamics and their consequences warrant careful consideration in both policy design and ongoing negotiations.
As US HTA capacity evolves too, policymakers face the question of whether a uniquely American framework - aligned with domestic values - could offer a more coherent alternative to international reference pricing. OHE’s upcoming Masterclass on Understanding Cost-Effectiveness Thresholds in Health Policy provides an opportunity to explore these issues in greater depth.
