List of Figures
Figure 1: US Health System Overview ……………………………………………………………………………………………………………………………………………. 10
Figure 2: : Average percent difference (%) between WAC price and BIG4 price by drug type ………. 12
Figure 3: Average price difference (%) between WAC price and Medicaid (New York) by drug type ………………………………………………………………………………………………………………………………………………………………………………………………………………………. 13
Figure 4: Average Price Difference (%) Between WAC and ASP Price in the US by Drug type ………….. 15
Figure 5: Number of newly priced on-patent drugs per year, 2021–25 …………………………………………………………….. 17
Figure 6: Average time (days) to pricing and reimbursement for on-patent reimbursed medicines approved after 2020, 5EU and US ……………………………………………………………………………………………………………………….. 18
Figure 7: Comparison of the average price per strength for patent-protected oncology medicines, 5EU and US …………………………………………………………………………………………………………………………………………………………………………… 19
Figure 8: Distribution of HTA decisions in the US and Germany since the start of ICER and G-BA ………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 20
Figure 9: The average percent difference per brand between WAC prices and MFPs, December 2025 …………………………………………………………………………………………………………………………………………………………………………………………………………………….. 22
Figure 10: The monthly average percentage change in WAC price per brand that applied price cuts for selected Medicare-negotiated products …………………………………………………………………………………………………………… 23
Figure 11: Key timeline of Most Favored Nation framework events ………………………………………………………………………. 24
Figure 12: Average percent difference per brand between WAC price and GENEROUS model-based price for top Medicaid drugs ………………………………………………………………………………………………………………………………………….. 29
Figure 13: Average percent difference per brand between WAC price and lowest ex-manufacturer price in GLOBE reference basket for top Medicare Part B drugs ………………………………………… 31
Figure 14: Average percent difference per brand between WAC price and lowest ex-manufacturer price in GUARD reference basket for top Medicare Part D drugs ……………………………………… 32
Figure 15: Distribution of countries using IRP by formula type ………………………………………………………………………………… 33
Figure 16: Distribution of reference basket sizes………………………………………………………………………………………………………………… 33
Figure 17: Average Q1 WAC price change (%) for Pfizer products that are included under Medicare Part B ………………………………………………………………………………………………………………………………………………………………………………………….. 35
Figure 18: Launch price (USD) of Lynozyfic (200 mg x 1 unit) in the US versus Germany …………………….. 38
Figure 19: Average launch sequencing for the US and IRP Guard and Globe countries ……………………. 39
Figure 20: Number of new product launches per GENEROUS/GLOBE/GUARD market, pre- and post-MFN executive order announcement ………………………………………………………………………………………………………………………….. 40
Figure 21: Ex-manufacturer historical prices (USD) – Repatha (evolocumab, 140 mg x 2 units) – US and Denmark ……………………………………………………………………………………………………………………………………………………………………………………….. 42
Figure 22: Average number of brands with at least one pack withdrawn in Europe, pre- and post-MFN executive order announcement ………………………………………………………………………………………………………………………….. 43
Figure 23: Top 20 products with the greatest average percentage difference per brand between the WAC price and DTC price listed on the TrumpRx platform ………………………………………………………. 45
Figure 24: Example of statement from TrumpRx platform of “most favored nation” price, Gonal-F, 450 IU, pen…………………………………………………………………………………………………………………………………………………………………………………………………. 48
