Presentation (CTI)

OBJECTIVES: Most Favoured Nation (MFN) policies are proposed to control pharmaceutical expenditure by anchoring domestic reimbursement to the lowest list prices in comparable international markets. However, applying MFN mechanisms to global pharmaceutical markets overlooks the structural realities of how medicines are valued ed. Focusing on the Asia-Pacific (APAC) region, this conceptual paper examines the tension between MFN policies and two critical market forces: commercial trade dynamics and established Health Technology Assessment (HTA) frameworks. First, MFN policies interact poorly with market-based trade incentives. Rather than addressing the primary drivers of high domestic prices, MFN redistributes pricing pressures. By disincentivising markets that utilise successful public negotiation, MFN creates commercial risks that may prompt pharmaceutical companies to delay or withhold medicine launches in smaller APAC markets to protect revenue in larger, high-price jurisdictions. Consequently, MFN risks generating global upward price pressure, inflating list prices, and establishing a bifurcated system. Smaller regional markets experience delayed access contrasting with those able to achieve higher prices. Second, MFN mechanisms bypass established HTA frameworks central to some APAC health systems, such as Australia, South Korea, Japan and Taiwan. Whereas HTA evaluates clinical value, cost-effectiveness, and budget impact to inform confidential pricing agreements tailored to local epidemiology. MFN pricing assumes the lowest international price is universally applicable, thereby stripping away local context. This approach threatens not only HTA and value assessment, but also confidential negotiations and managed entry agreements that are sometimes necessary to balance equitable access with health system sustainability.Ultimately, international pricing frameworks must move beyond rigid price application and MFN clauses. We propose that future policies must conceptualise global market-based trade realities while preserving the localised, evidence-driven evaluations that underpin robust HTA in the Asia-Pacific region.
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