Over the past five months, numerous pharmaceutical companies have reached agreements with the Trump Administration to voluntarily reduce list prices for essential drugs. These measures aim to align with a most favored nation (MFN) drug pricing model for newly launched medications. This initiative could potentially lower drug costs in the United States for high-demand treatments such as semaglutide (Ozempic, Wegovy; Novo Nordisk), apixaban (Eliquis; Bristol Myers Squibb), and tirzepatide (Mounjaro, Zepbound; Eli Lilly). As a result, these prices may align more closely with those found in other high-income countries.
Pharmacists play a crucial role in navigating these changes, as they will impact both patient costs and drug availability. According to Ned Milenkovich, PharmD, JD, and member of the Pharmacy Times Editorial Advisory Board, understanding the implications of MFN is vital. He emphasized that pharmacists can expect significant alterations in their workflows, including more formulary checks and potential supply disruptions.
Understanding the Most Favored Nation Model
The MFN pricing model establishes a framework where the United States seeks drug prices linked to the lowest prices manufacturers offer in other countries. This strategy serves as a form of negotiating leverage. Companies that agree to reduce prices can benefit from support for their U.S. manufacturing operations and relief from financial penalties.
Pfizer was among the first companies to announce its compliance with MFN pricing, committing to lower costs for a significant portion of its primary care treatments. The savings on select specialty brands are expected to vary, with reductions averaging between 50% and 85%. The Trump Administration’s push for these changes intensified with a May 2025 executive order threatening strict regulations and investigations if companies did not comply voluntarily.
In exchange for their cooperation, pharmaceutical companies have been granted grace periods from tariffs on drugs imported to the U.S. These tariffs, introduced in October 2025, were based on alleged violations of the Trade Expansion Act. Companies have also committed to enhancing their manufacturing capabilities in the United States, a key demand from the administration.
Novo Nordisk’s announcement particularly focused on expanding access to its weight loss drug, semaglutide. Through the yet-to-be-launched TrumpRx direct-to-consumer (DTC) purchasing platform, the company plans to offer semaglutide at reduced prices for Medicare Part D and Medicaid patients.
Anticipated Changes for Pharmacy Practice
The MFN model promises to alter pharmacy practice by affecting drug costs, availability, and pharmacy workflows with little preparation time. Milenkovich noted that uncertainty remains regarding patients’ out-of-pocket expenses. While potential savings could reduce costs at the point of sale, there is a possibility that these savings may be driven primarily by rebates rather than direct reductions in patient expenses.
Additionally, some patients may experience increased costs due to formulary changes or additional utilization controls. Delays in drug fulfillment resulting from MFN could present access barriers, even if a prescription is covered. Milenkovich illustrated this complex situation by stating, “Think of it as two pricing tracks at once.” He explained that while direct-channel discounts are available, list prices may still rise, complicating patient billing.
Pharmaceutical companies like EMD Serono have announced plans to offer DTC sales of their IVF therapies at significantly discounted prices, potentially providing patients with an 84% discount off list prices when using a typical IVF protocol.
To prepare for these upcoming changes, pharmacists must ensure operational readiness. Milenkovich highlighted the need to address timing, scope, and supply availability as these factors will quickly influence access and patient costs.
Pharmacists should tighten real-time benefit and formulary checks, readying templates for patient counseling on prescriber outreach, prior authorizations, and alternative recommendations. Monitoring acquisition costs against reimbursement rates will be essential as well.
Furthermore, patient education will play a pivotal role in this transition. Pharmacists can proactively manage patient expectations regarding price variability and coverage changes, encouraging them to check medication costs before pickup. Discussing lower-cost options, such as generics or therapeutic alternatives, will also be beneficial. If cost becomes a barrier, pharmacists can guide patients through assistance programs and potential exception requests.
Milenkovich concluded with practical advice for navigating the MFN landscape: “Standardize team counseling language and handoffs so every patient receives the same clear explanation, options, and timelines—supporting trust when prices and access shift unexpectedly.”
As the pharmaceutical landscape evolves, pharmacists must adapt to these changes to ensure their patients receive the best possible care and support.
