Presentation (CTI)

OBJECTIVES: The U.S.’s implementation of Most-Favoured-Nation (MFN) pricing has imported international reference pricing into the world’s largest pharmaceutical market. MFN aims to achieve price convergence: lowering what the U.S. pays and raising ex-U.S. prices, by linking U.S. prices to those abroad and using trade pressures such as tariffs. At the same time, many European countries are trying to contain costs and are facing their own pharmaceutical policy changes, which may pull responses in different directions. This research examines the divergent ways in which European health systems—inside and outside the reference baskets—are responding to MFN, and what country-specific characteristics might shape these responses.
METHODS: We adopted a mixed-methods design, combining policy analysis with country case studies, spanning systems inside and outside the reference baskets. For each country, we characterise the realised or proposed response and whether it moves prices towards convergence or away from it, mapping responses against reference-pricing exposure and the value frameworks invoked to justify spending. A global expert council—spanning policy, trade, payer, government and academic perspectives—convened across the year, culminating in a formal elicitation to inform the analysis.
RESULTS: National responses diverge. The UK has struck a bilateral trade deal raising branded-medicine spending; Switzerland is weighing measures to lift spending on future launches; Sweden, facing indirect exposure, is reconsidering its willingness to pay; and Germany has doubled down on cost containment. Justifications increasingly reach beyond health maximisation toward industrial competitiveness and security of supply.
CONCLUSIONS: Europe is responding to MFN through a patchwork of national strategies shaped by basket position, fiscal room and political appetite—fragmentation that risks uneven access, though interactions with EU reforms could enable a more coordinated settlement. As pricing becomes inseparable from trade and industrial policy, international dialogue will be essential to safeguard both innovation and equitable access.