There’s a lot of pushback in Congress and the agencies against health technology assessment tools (like cost-utility analysis) that would facilitate value-based negotiations. The IRA functionally disallowed QALY analyses so we have some work to do educating Congress on this and reversing that …

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Our article was one of a few recent @jama.com articles on "Most Favored Nation" drug pricing and Medicare drug price negotiation by @dusetzinas.bsky.social @thomasmd.bsky.social @benro.me and others that help explain the current state of the US drug pricing landscape.
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Absolutely-it is horrible that the pricing system has been gamed to maintain such high prices, especially for off patent drugs like lenalidomide!

10/ The MFN policy reflects urgency—but not durability or long-term strategy. With the right reforms, Medicare negotiation can do better: lower prices faster, fairer, and without derailing innovation.

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📰 Full Viewpoint at @jama.com:
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9/ These changes would:
• Lower prices sooner
• Improve equity and access
• Support innovation responsibly
• Strengthen Medicare and help private insurers who benchmark to Medicare rates

8/ Our proposal:
✔️ Let Medicare start negotiation 1 year after approval (like Germany)
✔️ Use independent cost-effectiveness assessments
✔️ Delink provider reimbursement from drug prices to align incentives

7/ But the IRA has a critical delay: negotiation only begins 9 years after launch (13 for biologics). During that gap, taxpayers and patients foot the bill for high prices at peak sales volume.

6/ We already have a better tool: Medicare drug price negotiation, passed in the 2022 Inflation Reduction Act. First-year results (which go into effect in 2026)?
📉 >50% reductions in negotiated drug prices
💸 ~$100B in projected savings over 10 years

5/ What’s worse, MFN could become self-defeating. If other countries raise their list prices in response, US prices would go up too, undermining the very goal of the policy.

4/ The 2025 order threatens to revoke FDA approvals or sue companies that resist. It also gives HHS just 30 days to set prices without specifying how. That’s a recipe for legal gridlock, not real reform.

3/ But MFN’s approach is deeply flawed:
❌ Legal and constitutional vulnerabilities
❌ Opaque global pricing benchmarks (obscured by secretive rebates)
❌ Risk to rare disease innovation
❌ Possible retaliation or unsafe drug imports
❌ Could unintentionally raise US prices

2/ The US pays 2–3x more for prescription drugs than peer nations. MFN aims to fix this by capping Medicare prices to the lowest paid abroad. For example: $17,000/month ➝ $900/month for a cancer drug like lenalidomide.

Even if you personally won't lose health insurance with this law, it will result in MANY hospital and clinic closures that will affect the quality of healthcare (including available doctors) that you receive.