Presentation (CTI)

OBJECTIVES: Growing evidence shows increased prices and delayed/withdrawn launches in ex-US markets since MFN was announced. However, how ex-US pricing and reimbursement (P&R) systems will adapt remains unclear. We explore payer perspectives on the impact of MFN on global P&R systems and implications for pharmaceutical access strategies.
METHODS: Payers and professionals with P&R experience in Canada, Italy, Spain, the UK and the USA were surveyed online to assess anticipated impacts of MFN on P&R and recommendations for the pharmaceutical industry for navigating this evolving landscape. In-depth interviews provided further insights.
RESULTS: All respondents anticipated MFN to reduce US list prices alongside price increases (15-20%) in Europe over the next 5 years. Delayed or no launch in ex-US markets was considered likely (average likelihood score [scale 1-10]: both 7). High-cost, high-value therapies, including for oncology, were identified as most exposed. 83% expected a moderate-to-large increase in innovative contracting and managed-entry agreements (MEAs), including outcome- and value-based models, to support acceptance of higher headline prices while limiting net price visibility. Payers considered Spain, Italy and the UK as more receptive to MEAs than Germany or France. Some payers anticipated national policy responses to attempt to restrict disclosure of confidential rebates to the US administration. Payers generally expected national pricing and evidence thresholds to be adapted to ensure that countries maintain access to innovative therapies.
CONCLUSIONS: Payers anticipated MFN to increase reliance on flexible financial agreements to maintain patient access while containing effective prices, with consensus on the growing importance of MEAs. However, views diverged across markets regarding confidential rebates, and uncertainty remains around the scale and timing of price changes. These findings highlight the evolving, context-specific nature of payer responses. Continued research with a broader range of countries is needed to better characterize the impact of MFN across ex-US markets.