Although major pharmaceutical companies have fallen in line with President Donald Trump’s “most favored nation” (MFN) drug pricing agenda, the specifics of their negotiated concessions and the actual impact on medicine affordability in the U.S. remain unclear.
Now, amid mounting scrutiny of those MFN deals by patient advocacy groups and others—and on the heels of a late-2025 effort by Democratic lawmakers to suss out the fine details—Democratic Sen. Ron Wyden of Oregon, ranking member of the Senate Finance Committee, is going to drugmakers directly for answers.
Backed by six other Senate Democrats, Wyden has sent out 11 letters to as many pharmaceutical makers, seeking clarity on whether there is “any evidence that these deals will benefit American patients and taxpayers in terms of savings to the Medicaid program,” according to a March 6 press release.
The senators’ inquiry specifically calls on drugmakers behind MFN agreements to provide information on which of their drugs fall under the accords, what the MFN prices for those drugs are and what state Medicaid programs are actually expected to pay in the wake of the announcements.
According to the Senate Finance Committee, letters have been sent out to AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Roche’s Genentech, Gilead Sciences, GSK, Johnson & Johnson, Merck & Co., Novartis and Sanofi.
Fierce Pharma has reached out to the companies for comment.
The latest salvo of letters comes after Wyden and other senators made similar requests of Pfizer, AstraZeneca, Novo Nordisk and Eli Lilly in December.
Wyden and the other senators’ MFN concerns are driven, at least in part, by Trump’s passing of the Republican reconciliation bill on July 4 last year, which cut nearly $900 billion from the U.S. Medicaid program, according to the letter (PDF).
Given the thinner margins upon which state Medicaid programs must now operate, the lawmakers specifically want to know whether “the prices [the companies] will make available on these drugs are actually lower than the net pricing states currently receive on the same products in Medicaid,” the letter continues.
Wyden and the senators have given the drugmakers a March 23 deadline to respond, stressing that states need timely access to the information to make budgetary decisions prompted by loss of Medicaid funding.
Scrutiny intensifies
Skepticism of MFN and other related ventures like the government’s cash-pay drug purchasing portal TrumpRx.gov appears to be mounting among both Trump’s critics and allies.
In late January, consumer advocacy group Public Citizen filed a Freedom of Information Act (FOIA) lawsuit against the Department of Health and Human Services in its own bid to extract more information on the government’s opaque MFN agreements.
“Trump and RFK Jr. pledged ‘radical transparency,’” Peter Maybarduk, Public Citizen’s access to medicines director, said in a release at the time. “Instead they’ve given us secret deals with drugmakers.”
Maybarduk added that the “secrecy” surrounding the deals makes it impossible to determine their effectiveness in lowering certain drug prices.
Meanwhile, some 50 leaders of free-market and conservative organizations wrote a letter (PDF) to Congress in February calling on the lawmakers to reject Trump’s MFN policy, which they suggested would “import socialist price controls and values into our country.”
The organizations made their push after Trump’s “Great Healthcare Plan,” unveiled earlier this year, invoked Congress to codify the president’s MFN policies.
And last month, John Barkett, a former senior policy advisor in the Biden administration, agreed that more details are needed on the slate of recent government-industry tie-ups.
“I think it would be helpful for all parties to reveal what the deals actually say,” Barkett said in a recent interview with Fierce. “In the Oval Office, the administration leaders have gotten up there and said, ‘this is the biggest drug pricing policy deal to ever happen.’ That’s an odd thing to say when you’re not willing to reveal the details of it.”
Barket also questioned whether the MFN-negotiated prices might differ from those paid by Medicaid, and how the policy will affect, if at all, people covered by Medicare and commercial insurance.
So far, the following Big Pharma companies have signed onto MFN agreements with the White House: AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, BMS, Lilly, Merck KGaA’s EMD Serono, Genentech, Gilead, GSK, J&J, Merck, Novartis, Novo Nordisk, Pfizer and Sanofi.
Though the exact terms remain confidential, the details of the deals as advertised have been broadly similar, winning concessions from drugmakers to discount select medicines’ list prices, broaden direct-to-consumer sales avenues and list certain drugs on TrumpRx.gov. Many companies have pointed to several examples of medicines they plan to discount, but the full scope of the agreements remains unclear.
In return for those pledges—typically alongside commitments to invest in new U.S. infrastructure projects—MFN companies have also won immunity to the Trump administration’s pharmaceutical tariff threats.
