Presentation (CTI)

OBJECTIVES: Most Favoured Nation (MFN) is a US pricing policy framework - established via President Trump's May 2025 Executive Order. It aims to align US drug prices with the lowest prices paid in economically comparable OECD countries. This research aims to quantify EU5 payer awareness, initial observed impact, and anticipated procedural responses to MFN.
METHODS: A structured survey was conducted with N=15 ex-payer experts across France, Germany, Italy, Spain and UK (N=3 per market). Respondents rated awareness, observed market impact, level of concern, the desirability for national process change, and likelihood of actual process change, each on a 1-5 Likert scale, with open-text justification.
RESULTS: Awareness was high (mean 4.21/5.0), with all but N=2 French respondents reporting maximal awareness (5.0/5.0). Observed market impact remained low (mean 2.31/5.0), concentrated in the UK following ICER updates, and only N=1 German respondent noted fewer than expected European launches. Concern varied across markets (mean 3.0/5.0), with the UK the most apprehensive (mean 5.0/5.0) given >95% of NICE recommendations depend on confidential discounts that may now risk US net pricing. Predicted manufacturer behaviours included delayed/non-launches for incremental-benefit "me-too" products and withdrawal of low-priced products from MFN reference markets. 57% of respondents felt national access processes should change, and 66% expected policy change in response to MFN. Italy and France expressed the lowest concern; N=2 Italian respondents and N=1 French respondent explicitly anticipated MFN dilution, either via tariff exemptions or change of US administration.
CONCLUSIONS: The MFN policy is being met with heterogeneous payer reactions, with most payers expressing concern given manufacturer behaviour to protect US pricing. The UK reflects the highest apprehension, likely driven by already declining prioritization of UK launches, whereas Italian and French payers question MFN’s long-term durability. Regardless, EU5 HTA policy responses are anticipated, including expanded confidential discounting and bespoke deal-making between manufacturers and payers.