Only a handful of the top pharmas have signed Most Favored Nation drug pricing deals with the White House, while smaller biotechs continue to hang in limbo.
Just because a handful of Big Pharmas have signed drug pricing agreements with the White House doesn’t mean the Most Favored Nation battle is over. Experts say that, despite the headline deals, drug pricing policy is set to dog pharma into the new year.
“The biopharma world is adapting to an environment with a lot more policy and geopolitical uncertainty than we’ve had in the past,” Greg Graves, senior partner for McKinsey’s life sciences practice, told BioSpace. “We have new sources of uncertainty that we’re having to absorb beyond the traditional commercial potential, technical risk, regulatory risks.”
Graves said that MFN drug pricing defined 2025—with a little side of tariff uncertainty as the president used the threat of import taxes to push pharmas into lowering prices.
While all of these policy issues were happening, Graves said, pharmas still had to run the everyday business—managing upcoming loss of exclusivity events, launch strategies, delivering on the portfolio and more. MFN was a bolt of lightning through pharma C-suites, particularly putting pressure on the CEO.
“I don’t think any one person except the CEO can solve the MFN question or at least figure out how you’re going to address it,” Graves said.
Pfizer, AstraZeneca, Amgen, Novo Nordisk and Eli Lilly reached agreements with the White House in the fall. Right before Christmas, Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead Sciences, GSK, Merck, Novartis and Sanofi also signed on.
Among the many companies that haven’t yet is Biogen. CEO Chris Viehbacher recently told Stifel that the MFN debate has not impacted his company so far and that he believes, if it does, it would affect only new product launches, not existing items in the company’s portfolio.
“Mr. Viehbacher does believe the worst has passed,” Stifel wrote, after a meeting with the executive. “For the industry though, the looming threat of MFN if this does persist may create more thought on how to price new drugs in different markets in the world.”
Early MFN Deals Ease Overhang Going Into 2026
When the specter of MFN was first raised by President Donald Trump in the spring, the industry cried out while analysts predicted doom and gloom. CEOs such as AstraZeneca’s Pascal Soriot used their earnings call platform to suggest that other nations need to pay more. This message seemed to work on Trump. By the end of the year, he had secured a deal that will see the U.K. pay more for innovative medicines.
Indeed, for U.S. biopharmas, the worst-case scenario did not come to pass, William Blair wrote in a year-end outlook. “We believe investors are beginning to view the existential risks to the industry as unlikely to materialize, and believe next year is setting up to be a better year than this year for the first time in several years,” the firm said.
Speaking to investors on Tuesday, Pfizer executives celebrated the signing of the MFN agreement. “It relieves a significant headwind and allows us to be much more planful and certain about the environment in which we’ll operate in,” CFO Dave Denton said.
Industry analysts said that Pfizer managed to negotiate a deal with limited impact, as many of the drugs within the agreement were already declining in price or headed for patent cliffs. CEO Albert Bourla, however, stressed during the guidance call that the impact of the MFN agreement is not “immaterial.”
“I think you should assume there is an impact as we always said,” Bourla insisted. The New York pharma lowered its 2026 revenue guidance last week to $62.5 billion, missing analyst consensus.
For all the companies that have yet to sign on, the impact will be felt at least in terms of time. They will need to go through the same process that Pfizer has to factor in the impacts and explain to investors how any pricing changes will impact earnings, Graves said.
“We’re still in the early innings of the dealmaking,” Graves said. Not even half of the top pharmas have signed a deal yet, he noted. Biotech hasn’t even begun.
Still, Guggenheim Securities sees the events of 2025 as laying the groundwork for a more stable 2026. The pharma sector climbed above the S&P 500 year-to-date performance index after pharmas signed a clutch of MFN deals, suggesting that investors are breathing a sigh of relief.
This year, “peak uncertainty in drug pricing limited confidence in pharma earnings,” Guggenheim noted. Also factoring in was chaos at the nation’s health agencies, including controversial leadership picks, fluctuating policy and the potential for drug approval delays at the FDA.
But going into the New Year, things are looking up, the firm continued. “We believe the industry’s progress in 2025 lays a solid foundation for a return to fundamental share appreciation in 2026 with a focus on sales and earnings growth and clinical execution, bolstered by M&A to address major 2026-2032 patent cliffs.”
Open Questions for Biopharma as MFN Threat Continues
One overhang heading into 2026 is that the direct-to-consumer TrumpRx platform is set to launch, which is when these deals will come into effect.
“Despite headline price reductions, it remains uncertain whether the TrumpRx model will meaningfully lower patient out-of-pocket cost, although the benefit to pharma companies is clear as they avoid the potential for heavy import tariffs,” PitchBook wrote in a 2026 preview.
How MFN might impact biotechs is another question mark right now. The Trump administration has focused on Big Pharmas, leaving smaller companies out of the picture—for now. Graves said this is a big risk for biotech heading into 2026.
“A lot of the dynamics right now are favoring larger companies,” Graves said. Big Pharmas have much greater leeway to make tough calls, with lots of capital on hand to absorb these impacts. If a Big Pharma needs to defer a launch, they can do that. For biotechs, a single launch is often a make-or-break event.
Biogen’s Viehbacher told Stifel much the same. He said that he has spent time on Capitol Hill speaking to members of Congress and does not believe they intend to codify something like MFN into law. If they did, that could force biotechs such as Biogen to address it, but Viehbacher “believes that biotech has a lot of support from Congress,” Stifel wrote.
Where smaller biotechs could be troubled is in the continued FDA disruptions, Viehbacher said, because these companies require more interactions with the FDA to get their drugs across the finish line.
Biotechs and investment firms are keenly aware of the policy issues that have been impacting their pharma peers. A recent survey by ICON Global of biotech leaders, influencers and funders worldwide found that 66% believe changing regulatory requirements would impact their organizations in 2025, compared to 56% in 2023. Geopolitical uncertainty rose as a key concern to 53% for the year, compared to just 26% two years before.
“Regulatory, policy and tariff changes will undoubtedly impact biotechs worldwide,” the ICON survey stated. “Whether those impacts will be positive or negative remains to be seen and will depend on the individual companies’ abilities to maximize opportunities and mitigate threats.”
