Ned Milenkovich, PharmD, JD

President Trump’s executive order pushing for most-favored-nation (MFN) pricing for pharmaceuticals sent shockwaves through the industry. While most people agree that healthcare and pharmaceuticals are often prohibitively expensive and patients are often unable to afford the treatments they need, forcing drug prices down in the US can have other consequences.

Pharmaceutical Commerce held the first in a series of executive webinars on Wednesday, Sept. 10, 2025, bringing together industry experts to discuss the potential impact of MFN on pharma and how the industry can strategize ahead of its implementation. Hosted by Ned Milenkovich, head of health care practice at Much Shelist and editorial advisor for Pharmacy Times, the panel included:

• Brian Corvino: principal and global market access practice leader with Deloitte
• Neal Masia, PhD: co-founder and CEO at EntityRisk, Inc.
• Ali Pashazadeh: founder, chairman, and CEO at Treehill Partners
• George Van Antwerp, MBA; senior vice president of product innovation and strategic planning at Prime Therapeutics

How did we get here?

The discussion began with Corvino laying the groundwork for the current landscape. As he explained, “There’s a long history of the concept of MFN in US trade policy. That being said, that issue has become very active in drug pricing in the last year. Earlier this year, two executive orders reintroduced the topic of MFN for drug pricing.”

Brian Corvino

He continued, “The current administration continues to lay the groundwork for the drug pricing environment, specifically in the US. There’s important connectivity with this and the Inflation Reduction Act (IRA) and whether some of guidance or direct negotiations, 340B drug price transparency, ASP calculation, and not to mention tax trade and tariff policy.”

Masia chimed in, “I think this is the administration saying what’s the worst imaginable thing I can do within the bounds of my authority that I can do to the industry to get them to the table so that they will announce and change some behaviors. The specifics of MFN may mostly be unworkable, but the underlying goal is clear: announcements about lower drug prices in some way.”

When asked who stands to gain and who stands to lose from the MFN order, Pashazadeh answered, “The only person I care about here is the patient. Everybody else is a bystander or observer in this conversation. Having graduated 30 years ago and lived through MFN in Europe, the result is that Europe is optimizing for the 95^th percentile (for every 100 patients that come in, we’re treating 95 in the most cost effective manner). What happens to the remaining patients? They do matter. The number of times I’m in a hospital and a patient needs a treatment but the hospital administrator is saying that it’s not cost effective…”

Ali Pashazadeh

“My view is,” he continued, “we've got legislature, lawyers, and everyone else who is going to negotiate this and put frameworks in place. They must keep in mind at the end of the day there is someone's mother, father, or child who is going to pay the price.

How will pharma respond, and how will that response play out?

The conversation then turned to the topic of pharma’s response, with Van Antwerp explaining, “During the last Trump administration, there were multiple legal challenges from the industry. I’m sure we will see similar things play out here. In a perfect world, the pharma companies would just lower the prices and say that they don’t want to deal with the complexity of the system. They would show the administration that they can lower list prices and that they’re willing to be flexible.”

George Van Antwerp, MBA

“The challenge is that 80% of the profits are coming from the US, it is the largest global market,” he continued. “Most companies would struggle to not be in the US long term. When it comes to innovation, it doesn’t require unchecked pricing to be allowed in order to exist.”

Does MFN and other pricing policies pursued by the administration put biopharma innovation and the US’ position as the first-to-launch territory in jeopardy?

Masia replied to Van Antwerp’s comments, saying, “If pricing was really unchecked, then PBMs wouldn’t exist. Their entire business is to check the pricing power, which is why there is such a big gap between the list and net prices. This is likely why people like Donald Trump are annoyed, because it’s such a confusing mess and nobody really knows what the price of a drug really is.”

Neal Masia, PhD

Moving on to the topic of innovation, he said, “If you're thinking about MFN to say that the world is paying less, why can’t the US pay less, the answer that everybody is circling is that the US market is not what’s going to most affected in the near term. It’s the other markets where drugs do get launched in because the price bleeds through the whole system. In the US, from an R&D perspective, you would be picking and choosing the areas where the value is the clearest and everyone understands why this is a valuable innovation.”

The conversation then moved to closing thoughts, with Corvino summarizing his thoughts as, “This is a time where bringing ideas to the table is an absolute necessity. There’s a lot of ways to do that, so I encourage real activation and being part of shaping that policy. There’s been quite a bit of innovation that’s being discussed in terms of new models, and it’s time to thinking about bringing those models to the marketplace.”

Van Antwerp continued, “When any idea comes through, we look at it across three basic ways:

• Is it saving the patient money out of pocket
• Is it saving the client money?
• Is it simplifying healthcare or not?”