The impact of the United States most favored nation policies on prices of branded medicines and research and development.

OBJECTIVE

The Executive Order (EO) reintroducing the Most Favored Nation (MFN) policy sets out measures to lower prices of branded medicines in the United States (US) and increase them elsewhere.

METHODS

To understand the impact of the policy on prices and on pharmaceutical innovation, this paper reviews empirical literature on historic price trends in the US and other high-income countries, the impact of international reference pricing (IRP), and the impact of regulation and market conditions on Research and Development (R&D).

RESULTS

49 studies were included. List prices are greater in the US than other high-income countries, and the difference in net prices has widened in the last two decades. The IRP literature indicates that for some drugs, MFN might be able to reduce prices in the US and increase them in reference countries, particularly for drugs where Medicare and Medicaid have a high global market share. In other cases, firms may strategically delay or cancel launch in other countries to avoid price comparisons. It is likely that MFN will provoke a reduction in global pharma revenues and aggregate investment in R&D.

CONCLUSION

A few countries are increasing prices as part of trade deals with the US. If countries do not wish to increase prices, then they should expect, and prepare for, slower pharma innovation. From a public health perspective, it is not just aggregate R&D that matters, but whether R&D investment is directed to projects which are likely to promote the greatest health gain.