With the Trump administration having reached pricing deals with 16 Big Pharma companies—including Pfizer, AstraZeneca, Novartis, and Novo Nordisk among others—it is now bringing to light the companies that have not struck pricing deals of their own.¹

According to Reuters, some of the pharma companies that were not on the receiving end of President Trump’s May executive order (EO)² are interested in pursuing separate agreements in order to avoid tariffs.

What does the MFN drug pricing executive order require?

Trump had doubled down on the EO by issuing letters to some of largest pharmaceutical companies, expressing urgency for the United States to be treated as a most-favored nation (MFN) as it pertains to drug pricing. This would involve having US drug prices being less than or equal to the drug’s lowest price in other nations, as a way of establishing fairness.

The letters—which all have the same wording—explain what he looks to accomplish from the MFN order while providing a timeline for the next 60 days (originally Sept. 29) that they have to comply. This includes extending MFN pricing to Medicaid; guaranteeing MFN pricing for newly-launched drugs; returning increased revenues abroad to American patients and taxpayers; and providing for direct purchasing at MFN pricing.

Are companies now trying to negotiate their own drug pricing agreements?

Two lobbyists and additional industry sources reported to thepublication that companies have started contacting officials at both the White House and the Centers for Medicare & Medicaid Services in an effort to negotiate their own agreements. They declined to identify which companies are involved.

"The Trump administration of course wants to negotiate deals that meaningfully lower drug prices for American patients with every pharmaceutical company," White House spokesman Kush Desai mentioned in an email to Reuters.

As of now, the administration is yet to share how those companies should move forward if they haven’t received a letter from Trump. According to industry sources, companies are particularly concerned about new pilot programs that could establish Medicare drug prices across broad regions of the country. Per these programs, known as Globe and Guard, manufacturers would need to provide rebates on medicines covered by Medicare plans for millions of Americans aged 65 and older if US prices are higher than those charged internationally.

“The Globe and Guard Models are designated as ‘tests’ for seven and five years respectively. Various operational approaches will be used, but the main reason for the ‘test’ designation is probably the ability to stay within CMS authority and avoid the need for congressional approval,” noted Ed Schoonveld, value and access adviser for Schoonveld Advisory, LLC and author of The Price of Global Health, in a recent column for Pharma Commerce.

Could deal structures limit access for smaller biopharma companies?

According to Paul Hudson, CEO of Sanofi, the structure of these agreements—which some companies say shield them from future government price-setting efforts—could make it difficult for the government to extend comparable arrangements to smaller firms.

“It’s very difficult to deliver 30, 50, 80 deals from here. There may just be a sort of catch-all offer from the government or something to try and manage it a certain way,” he told Reuters and other media outlets at the JP Morgan Healthcare Conference last month.

References

1. Erman M. Pharma Companies Left Out of Trump's Drug-Pricing Deals Look for Way In. Reuters. February 11, 2026. Accessed February 12, 2026. https://www.reuters.com/business/healthcare-pharmaceuticals/pharma-companies-left-out-trumps-drug-pricing-deals-look-way-2026-02-11/

2. Hollan M. President Trump Announces Most-Favored-Nation Policy for Pharma Prices. Pharmaceuitcal Executive. May 12, 2025. Accessed February 12, 2026. https://www.pharmexec.com/view/president-trump-most-favored-nation-policy-prices