FAQ: Inside the Latest MFN Deals Signed by Nine Drugmakers

President Donald Trump announced nine new most-favored-nation (MFN) agreements with pharmaceutical manufacturers on Aug. 31, bringing the program to 26 companies the administration says account for 89% of the branded drug market.¹ The nine are mid-sized manufacturers, and their agreements pair Medicaid pricing concessions with $19.6 billion in near-term US manufacturing investment and donations to a federal active pharmaceutical ingredient stockpile.

Below are answers to the key questions about the expanded MFN agreements.

Which manufacturers signed MFN agreements, and what products are affected?

The nine new participants are Alcon, Astellas Pharma, BeOne Medicines, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva Pharmaceuticals and UCB.¹ The affected products span hemophilia, Parkinson's disease, macular degeneration, glaucoma, liver disease, dermatologic conditions and multiple cancers. The roster mixes specialty innovators and generics-heavy manufacturers, which means the concessions land across very different revenue structures.

What do the agreements actually commit these companies to?

Every state Medicaid program gains access to MFN pricing on the nine companies' products.¹ The agreements also extend MFN pricing to new medicines these manufacturers bring to market, and the White House frames them as preventing other countries from using price controls to benefit from American innovation without paying comparable prices. The Council of Economic Advisers has separately distinguished prospective MFN, covering future launches, from terms applying to drugs already marketed.²

Why are manufacturers signing voluntarily?

Tariff exposure is part of the calculus. An April 2026 executive order determined that imported pharmaceutical products present a national security threat and imposed additional tariffs, while linking relief to manufacturers' willingness to enter MFN pricing and domestic production agreements.³ Products from companies holding an MFN and onshoring agreement carry a 0% rate at least until 2029. The pricing concession therefore buys something concrete beyond goodwill, which distinguishes these arrangements from a purely voluntary framework.

What are the manufacturing and API commitments?

The nine companies pledged at least $19.6 billion collectively in near-term US manufacturing investment, and several are contributing material to the Strategic Active Pharmaceutical Ingredients Reserve, a stockpile intended to reduce dependence on foreign API sources.¹ UCB is contributing 163 tons of levetiracetam. Sun Pharma is contributing 71.4 tons of clindamycin and 6.75 tons of doxycycline. Teva is contributing 45 metric tons of metronidazole and 4.8 tons of amlodipine. Astellas is contributing 25 kilograms of tacrolimus.

Why should sourcing teams track the API donations specifically?

Because they signal how participating manufacturers may reallocate ingredient supply commitments. A company committing tonnage to a federal reserve is making a claim on production capacity that would otherwise serve commercial demand. The reserve is being built through pricing negotiations rather than through procurement, an unusual structure worth watching as a template for how supply-chain obligations get attached to unrelated concessions.

Do the MFN prices change what Medicaid beneficiaries pay, and where does the financial impact land?

No, not at the counter. Lindsay Bealor Greenleaf, head of market access policy strategy at ADVI, told sister publication Pharmaceutical Executive that Medicaid patients typically already pay between $4 and $8 at the pharmacy counter, and that the impact of the voluntary deals falls squarely on manufacturers.

What remains undisclosed about the terms?

The agreements themselves. Important questions remain about which products fall under MFN pricing, how applicable prices are determined and updated, how savings will be reflected in pharmacy costs, and how the arrangements interact with existing manufacturer contracts and government pricing obligations.⁴ Patients For Affordable Drugs noted that implementation and enforcement terms have not been made public.⁵ Downstream partners cannot adjust acquisition or reimbursement assumptions against terms they cannot read.

How could this affect pharmacy economics?

Not automatically in pharmacies' favor. Duane Morris flagged that lower manufacturer prices do not necessarily translate into improved pharmacy economics, because reimbursement depends on contractual formulas, published benchmarks, maximum allowable cost methodologies and dispensing fees that may not move in step with manufacturer pricing.⁴ If acquisition costs fall while reimbursement formulas still cover the cost of dispensing and patient services, pharmacies gain. If benchmarks or formulas reset faster than actual acquisition and operating costs come down, margins compress instead.

What comes next?

Twenty-six agreements still leave the framework resting on executive negotiation. The administration is pressing Congress to enact the Great Healthcare Plan, which would lower drug prices and insurance premiums, hold insurers accountable and expand price transparency.⁶ Company-by-company deals can be renegotiated or abandoned by a later administration. Statute cannot, which is why codification carries more weight for planning purposes than the roster count does.

References

1. The White House. Fact sheet: President Donald J. Trump announces deal with nine additional pharmaceutical manufacturers to lower drug prices for Americans. Aug. 31, 2026. https://www.whitehouse.gov/fact-sheets/2026/08/fact-sheet-president-donald-j-trump-announces-deal-with-nine-additional-pharmaceutical-manufacturers-to-lower-drug-prices-for-americans/
2. Council of Economic Advisers. Savings from most-favored-nation drug pricing policy. The White House. May 2026. https://www.whitehouse.gov/research/2026/05/savings-from-most-favored-nation-drug-pricing-policy/
3. Most-favored-nation drug pricing policy: executive actions, manufacturer agreements, and growing congressional scrutiny. Sidley Austin LLP. April 2026. https://www.sidley.com/en/insights/newsupdates/2026/04/most-favored-nation-drug-pricing-policy-executive-actions-manufacturer-agreements
4. Swichar JL, Wasser BA, Baniewicz N. Most-favored-nation drug pricing agreements expanded to nine additional pharmaceutical manufacturers. Duane Morris LLP. Sept. 2, 2026. https://www.duanemorris.com/alerts/most_favored_nation_drug_pricing_agreements_expanded_nine_additional_pharmaceutical_0926.html
5. Patients For Affordable Drugs reacts to new White House MFN agreements. Patients For Affordable Drugs. Aug. 31, 2026. https://www.patientsforaffordabledrugs.org/2026/08/31/patients-for-affordable-drugs-reacts-to-new-white-house-mfn-agreements/
6. The White House. Fact sheet: President Donald J. Trump calls on Congress to enact The Great Healthcare Plan. Jan. 15, 2026. https://www.whitehouse.gov/fact-sheets/2026/01/fact-sheet-president-donald-j-trump-calls-on-congress-to-enact-the-great-healthcare-plan/