ISPOR Stimulates Discussion About US Drug Price Negotiations in Inaugural Health Policy Retreat

Beth Fand Incollingo

ISPOR’s first-ever health policy retreat explored America’s Inflation Reduction Act (IRA) and the possibility that the United States will introduce most-favored-nation (MFN) drug pricing, highlighting how the measures are expected to affect payers, patients, and innovators.

An exclusive, invitation-only event for 30 of ISPOR’s corporate sponsors and selected health policy experts, the Health Policy Retreat 2025 was held June 14 at the Fairmount Georgetown in Washington, DC. Its intimate format was designed to enable both presenters and an audience of consultants, payers, patients, academics, and biopharmaceutical experts to speak freely.

“It’s an opportunity to ask the questions that are legitimately keeping you up at night,” Rob Abbott, ISPOR’s CEO and executive director, told the group.

Abbott said the gathering was the first of many ISPOR will host to discuss health policy issues.

“What we’re doing today is something that has been an aspiration for our Society for quite some time because ISPOR has always been and, importantly, always will be a steward of the science that underpins the profession of health economics and outcomes research (HEOR),” he said. “As we look to the future, it is absolutely vital that we think about how to use the rigor, evidence, and story of the science to inform health policy decision making.”

The retreat focused on the specifics of 2 policies: the Medicare Drug Price Negotiation Program and an executive order signed in May 2025 by President Donald Trump. The Medicare Drug Price Negotiation Program, created under the IRA of 2022, aims to make selected high-cost prescription medications more affordable for Medicare beneficiaries by allowing the Centers for Medicare & Medicaid Services (CMS) to negotiate prices with manufacturers. The executive order calls for manufacturers to lower drug prices to match the lowest amounts charged for the same medications in countries that are members of the Organisation for Economic Co-operation and Development and have per capita gross domestic product (GDP) numbers totaling at least 60% of America’s GDP.

In a keynote address, Kristi Martin, MS, MPA, healthcare director of the Camber Collective and a former leader with CMS, highlighted issues related to the measures that will likely be a focus for HEOR experts. Adding to that discussion in shorter talks were Sean Sullivan, PhD, a professor of pharmacy at the University of Washington; Stacie Dusetzina, PhD, an associate professor of health policy at Vanderbilt University Medical Center; and John O’Brien, PharmD, MPH, president and CEO of the National Pharmaceutical Council.

“As we look to the future, it is absolutely vital that we think about how to use the rigor, evidence, and story of the science to inform health policy decision making.”

Martin said that the changes stimulated by the IRA, including negotiated prices for selected high-cost drugs, a $2000 annual out-of-pocket cap on prescription medicine costs for beneficiaries, and a $35 limit on insulin prescription prices, constitute “the largest changes to the Part D program we’ve seen since its inception in 2003,” some of which will also affect Medicare Part B. The combined effects of the reforms are not yet fully clear, the speakers said, and adjustments may be needed.

They highlighted a number of questions for the HEOR community to consider:

• What is the fairest way to determine which drugs are eligible for price negotiation?

• How will commercial insurers devise prices for drugs that have Medicare-negotiated values?

• Is it fair that some drug types must be on the market longer than others before they can be considered for Medicare price negotiation, or does that discourage pharmaceutical companies from developing certain kinds of treatments?

• Does negotiation of drug prices disincentivize manufacturers from conducting postmarket research on those treatments or seeking additional indications?

• Should the United States establish a broader health technology assessment mechanism, or might a different system be needed, given the later life cycle of the drugs being assessed?

• How can the price negotiation process be kept transparent?

In sorting all that out, “we can really focus on the opportunities by thinking about how to engage in a dialogue that moves the ball forward,” Martin said.

Also during the day, a panel discussion titled “International Reference Pricing—What Does the Future Hold?” was moderated by Peter Neumann, ScD, director of the Center for the Evaluation of Risk in Health at Tufts Medical Center, and Laura Pizzi, PharmD, MPH, chief science officer at ISPOR. Panelists were Anthony Barisano, PharmD, vice president for global HEOR at Bristol-Myers Squibb; Katie Keith, JD, MPH, a director of the O’Neill Institute for National and Global Health Law; Sean Dickson, JD, MPH, a senior vice president with AHIP; and patient advocate Sue Peschin, MHS, president and CEO of the Alliance for Aging Research.

Discussion points included:

• The enforceability of the executive order mandating MFN pricing

• How tariffs might affect that pricing

• Whether it’s a good strategy for the United States to “import” drug prices based on other countries’ conceptions of value

• The possibility that MFN pricing will induce manufacturers to pull out of smaller foreign markets

• The potential for pharmaceutical companies to profit even if drugs are priced below their value

Because considerations about value are a part of all healthcare policy decisions, Pizzi queried the group about how ISPOR can help define the term.

“Many of us will have different views, but there’s a Venn diagram somewhere,” Barisano said. “Start by asking multiple stakeholders to choose the values they agree are worth including in pricing discussions—values that will ultimately give back to patients.”