Presentation (CTI)

OBJECTIVES: This analysis examines how Most Favored Nation (MFN) pricing model could reshape global launch strategies, by analyzing two high-expenditure Medicare drugs; Eylea for retinal disease and Biktarvy (HIV treatment). We quantify the price differences, potential financial impact and highlight implications to innovation and patient access.
METHODS: We analyzed 2023 Medicare data covering 339,000 Eylea and 83,000 Biktarvy beneficiaries. US wholesale prices ($1,896 per Eylea dose; $3,850 per month for Biktarvy) were compared to France ($642 and $578, respectively) and the UK ($1,120 and $1,117, respectively). MFN benchmark prices were derived from OECD countries with GDP per capita exceeding 60% of the US, using Canada’s price ratio (0.65) as the anchor, resulting in an MFN price of $1,336. Revenue projections leveraged CMS real-world utilization data.
RESULTS: The analysis revealed significant price disparities and revenue implications. Eylea’s US price is 195% higher than France and 69% higher than the UK. Biktarvy’s US price exceeds France by 566% and the UK by 245%. Under MFN implementation, projected revenue reductions exceed $200 million for Eylea and $900 million for Biktarvy, accounting only for Medicare population. Manufacturers would need to either increase treated patient volumes by over 20% or reduce R&D investment to maintain revenue levels.
CONCLUSIONS: MFN implementation risks creating therapy deserts in select reference countries as manufacturers will face impossible choices. Manufacturers’ gross revenue streams may face sudden strain under MFN pricing framework for Medicare. Secondly, the implementation of MFN US pricing may have cascading implications in global access to healthcare innovation as manufacturers may exit select international markets with low drug prices to protect their revenue streams in the US and R&D investment.