Following the blue tidal wave in the midterms that restored Democrats to power in both chambers of Congress, lawmakers on the left are leading a renewed effort to look under the hood of the White House’s controversial "most favored nation" (MFN) drug pricing deals.
Top Democratic legislators have called on more than two dozen drugmakers, including Pfizer, Eli Lilly, Novo, Roche and AbbVie, to immediately disclose the terms of their deals by sharing unredacted copies of the contracts along with any other related documents, The Washington Post first reported on Monday.
The email outreach effort was led by Reps. Frank Pallone Jr. of New Jersey and Virginia's Bobby Scott, alongside Sen. Ron Wyden of Oregon, The Post said, citing an unnamed source familiar with the move. Requests have now been sent to all 27 drugmakers that have inked MFN accords with the White House.
If the pharmas can’t turn over their records immediately, the lawmakers asked that they meet to make a submission plan in the next two weeks, according to The Post's source.
The investigation into the opaque, high-profile deals, along with several of the Trump Administration’s other pharma policies, are almost guaranteed to get “noisy" in the wake of the midterms, experts told Fierce. But the real-time implications for drugmakers and their strategies are less clear.
Changes to White House pharma policies in the near term are unlikely, but as the power dynamics change in 2027, drugmakers must—as always—remain ready to adapt.
“The midterms change the checks and balances around pharma policy more than they change its direction overnight,” Chris Kachinsky, leader of U.S. tax sectors and life sciences tax industry at KPMG, told Fierce. Tariffs, MFN deals, the push for U.S. drug manufacturing and other policies are “already in motion and won’t simply change course because control of Congress has shifted,” she said.
Several Big Pharmas echoed Kachinsky’s stance as leadership at Novo and Pfizer assured investors over their respective Q3 earnings calls that the MFN deals they signed in 2025 were not in jeopardy.
“What will change is the level of congressional oversight and scrutiny around those policies,” Kachinsky suspects.
While better drug pricing and domestic manufacturing have bipartisan appeal for economic and national security reasons, the Democrat’s midterm sweep is considered a direct rebuke to President Trump. In this environment, the vast amount of money spent on medicines will almost certainly become “ultra political,” Glenn Hunzinger, PwC's U.S. health industries leader, told Fierce in an interview.
While pricing pressures may not change immediately, the rhetoric likely will, Hunzinger said. “It's going to be easy to get distracted by, I think, all the noise.”
Instead, he said drugmakers’ best bet is to keep their heads down and optimize. In the face of pricing pressures—from legislators, patent cliffs, limited capital allocation, and beyond—more efficiency is king, Hunzinger stressed.
Given pharma's limited price elasticity, leadership will need to prioritize operational efficiencies, trimming unnecessary admin costs and adopting technology where possible so they can deploy capital where it counts—innovation. And the industry has room for improvement there, too: In 2025, administrative spending at the top 13 pharmaceutical companies outpaced R&D spending by more than $18 billion.
In effect, Hunzinger's call for efficiency sounds a lot like the strategy many drugmakers are already deploying in the face of the industry's major looming patent cliff. Many company leaders are currently “driving their business as hard as possible to change,” he added. “I think most of the companies have just gotten used to the volatility and have built muscles” that allow them to deal with it, he suggested.
Kachinsky at KPMG agreed with the call to stay agile, advising pharma leaders to continue to “scenario-plan” for how shifts in pricing, trade and manufacturing policy “could affect investment, supply chains and broader business strategy.”
That overall drive toward resilience appears to be paying off. In Pfizer's recent third-quarter earnings call, CEO Alberto Bourla recalled his anxiety last year around impending U.S. import duties and drug pricing reform: “In 2025, I was really scared about the implications that either tariffs or MFN could have,” he explained to investors. “I think through the successful navigation of those issues, we brought the stability that is now projected to last.”
Analysts have agreed that no major disruptions are likely to take place on the policy front until at least 2028. The team at Leerink Partners suggested in a recent note that Democrats will likely have “bigger fish to fry” than drug pricing in 2027. PwC's Hunzinger, for his part, speculated that funding cuts to Medicaid and the NIH would likely be higher on the left’s agenda.
Still, as another election year rolls around in 2028, the story could change once again. Democrats could spearhead drug pricing policy changes as they vie to take control of the Oval Office. Or, just as likely, the Trump administration could move to renegotiating the terms of existing MFN deals ahead of their December 2028 expiration and the fall presidential election, as it has suggested it might.
Earlier this year, Trump called for Congress to write the voluntary MFN deals into law. While there has been bipartisan appetite for reining in America’s steep prescription drug costs, legislators have so far resisted the push.