Amid lawmaker and advocacy group efforts to parse the White House’s “most favored nation” drug pricing deals with drugmakers, newly revealed—yet heavily redacted—information is reigniting concerns about just who exactly the Trump administration policy benefits.
Through a Freedom of Information Act request, Public Citizen over the weekend surfaced separate drug pricing agreements between the U.S. government and Pfizer and Eli Lilly, both announced last year.
The nonprofit warned that, among the information available, it has uncovered “concerning terms that will help facilitate pharma companies charging more for drugs abroad or discontinuing supplying drugs in other countries so that they can continue to charge U.S. customers high prices.”
The redaction process, meanwhile, continues to complicate efforts by the public “to assess the true impact of the secret deals made with the Trump White House,” Public Citizen added in a release Saturday, flagging additional questions around the specific MFN implications for GLP-1 drugs like those from Novo and Lilly, plus the timing and truthfulness of previous public-facing statements on Pfizer’s deal in particular.
Last year, Pfizer became the first Big Pharma to strike an MFN pact with The White House, in a process that has now repeated to include a total 27 companies, including a more recent crop of generally mid-sized manufacturers. The agreements have seen drugmakers make high-value manufacturing and R&D pledges in the U.S., plus commitments to level Medicaid drug prices according to those paid in a basket of high-income comparator countries.
In turn, pharma companies have broadly secured windows of immunity from the Trump administration’s drug import tariffs, plus other potential benefits that remain less clear.
Public Citizen stressed that it supports efforts to lower drug costs for people in America, while caveating that the MFN deals as understood—and with added color from companies on the policy’s potential impact to their bottom lines—suggest “Trump has exaggerated his recent drug pricing achievements.”
The obscure nature of the deals has spurred action from multiple groups since last year, including Public Citizen, which filed a FOIA lawsuit against the HHS and the U.S. Commerce Department back in January after the government failed to hand over documents related to the policy.
In March, a clutch of Democratic lawmakers sought clarity around “any evidence that these deals will benefit American patients and taxpayers in terms of savings to the Medicaid program.”
Questions around the scope of the specific drugs covered in the deals, their precise MFN prices, and what state programs should actually expect to pay were key questions in the letters, and they remain topics of uncertainty in Public Citizen’s latest warning, too.
In one key revelation surfaced by Public Citizen, Pfizer’s deal includes a provision in which the Department of Health and Human Services is slated to receive a portion of the New York drugmaker’s increased revenue if it’s able to increase drug prices overseas—another key facet of the MFN agenda, which has accused other high-income countries of failing to pay their fair share for biopharmaceutical innovation.
But what HHS intends to do with those funds beyond a broad pledge to lower costs for U.S. patients remains vague, according to the text of the deal published Saturday.
When reached for comment, an HHS spokesperson pointed Fierce to an exchange on X in which White House press representative Kush Desai implied Public Citizen wasn’t revealing anything new, suggesting that the information was already available in “the fact sheets that the White House put out for every single MFN deal.”
In a statement to Bloomberg, a Pfizer spokesperson said the company stands “by our belief that the agreement Pfizer voluntarily reached with the administration last September is a win for American patients” and will help secure lower costs for patients and redistribute the financial burden of R&D.
Pfizer and the White House did not immediately respond to Fierce’s request for comment on the published terms.
In another concerning turn, Public Citizen contends that Pfizer’s and Lilly’s MFN deals were publicized by the government as final “months before it ironed out crucial details and secured binding commitments” from the drugmakers. In fact, it now appears Pfizer only entered a definitive deal in late February, nearly five months after the Trump administration first said it had completed its negotiations and inked an accord with the company.
Public Citizen additionally cautioned that Pfizer’s agreement includes a loophole in which those terms—still not fully clear—supersede Medicaid’s GENEROUS model, which will determine how state Medicaid programs can take advantage of MFN pricing. And in the case of Lilly, the advocacy group flagged “some concerning giveaways,” including a carveout for GLP-1 obesity drugs that it warned “could cost Medicaid nearly $1.7 billion in savings,” potentially undercutting the policy’s stated purpose.
Public citizen warned that precise U.S. investment commitments and the exact parameters of the companies’ tariff exemptions weren’t clear either.
The group’s admonitions come right on the heels of a letter from John Crowly, head of the influential U.S. trade group the Biotechnology Innovation Organization, seeking information from Jeffrey Kessler, under secretary of commerce for industry and security, on the administration’s Section 232 tariffs for patented drugs ahead of a looming implementation deadline.
Crowley said last week that despite his organization’s “repeated requests” for clarification, it was “still awaiting guidance” on how certain products—including orphan drugs, cell and gene therapies and designated medical countermeasures—would be exempt from trade duty considerations, plus the impact of Trump’s tariffs on pre-commercial patented medicines, branded off-patent medicines and other unique products.
Lawmakers in the United Kingdom have also taken recent steps to increase scrutiny on a landmark pharmaceutical trade deal inked between their country and the U.S. earlier this year, which will keep tariffs on U.K. pharma imports at 0% in exchange for higher spending pledges on novel medicines by England’s National Health Service.
In their appeal to the U.K.’s National Audit Office, the MPs pointed to their own repeated and failed attempts to gather the particulars on the agreement, which was also inspired by Trump’s MFN-tariff policy double whammy.