White House strikes second round of 'most favored nation' drug pricing deals with nine mid-sized pharmaceutical companies

The Trump administration has unveiled a second wave of drug pricing agreements under its most favored nation, or MFN, policy framework, this time securing deals with nine mid-sized pharmaceutical companies including Alcon (ALC), Astellas Pharma (ALPMY), BeOne Medicines (ONC), BridgeBio (BBIO), CSL, Kyowa Kirin (4151), Sun Pharma (SUNPHARMA), Teva Pharmaceuticals (TEVA) and UCB (UCB).

The agreements are designed to lower Medicaid prices on treatments spanning hemophilia, Parkinson's disease, macular degeneration, glaucoma, liver disease, skin conditions and multiple forms of cancer. Specific drugs covered and precise discount levels were not disclosed.

The new round follows the completion of the administration's first tranche of MFN deals — concluded with 17 of the industry's largest players from last year through late April 2026, when Regeneron became the last to sign. That initial cohort included Pfizer (PFE), AstraZeneca (AZN), Roche (RHHBY), Novartis (NVS) and Johnson & Johnson (JNJ), among others. Mid-sized companies were excluded from that first round.

The MFN framework seeks to align US prescription drug prices with net prices paid in a basket of high-income comparator countries, including Canada, Denmark, France, Germany, Italy, Japan, Switzerland and the UK. Critics have questioned the true impact of the deals on patient affordability, with the fine print of previous agreements remaining largely opaque.

As with the first round, the participating companies have paired pricing commitments with domestic investment pledges, collectively committing at least $19.6bn to US manufacturing operations. Several firms have also agreed to donate active pharmaceutical ingredients to the US Strategic Active Pharmaceutical Ingredients Reserve, known as SAPIR, a government stockpile intended to reduce dependence on foreign suppliers. UCB will contribute 163 tons of the seizure drug levetiracetam; Sun Pharma will provide 71.4 tons of the antibiotic clindamycin and 6.75 tons of doxycycline; Teva will supply 45 tons of the antibiotic metronidazole and 4.8 tons of the hypertensive drug amlodipine; and Astellas will add 25 kilograms of the immunosuppressant tacrolimus.

Tariff relief appears to remain a central incentive, even though the White House made no explicit mention of duties in its Monday release. Individual company statements suggested otherwise: UCB's announcement indicated that tariff immunity remained part of the MFN arrangement, while oncology specialist BeOne said it had secured an exemption from Section 232 pharmaceutical tariffs in connection with its US manufacturing investments.

BridgeBio, said it would expand state Medicaid access to its ATTR-CM treatment under the GENEROUS industry-government rebate framework, and added that it did not expect to be subject to future pricing mandates. The company reported $502.1mn in full-year revenues in 2025.

CSL linked its participation to a recently announced $1.5bn manufacturing plant expansion near Chicago, pledging to offer Medicaid access to its drugs at prices in line with other developed markets and to apply similar pricing to any future therapies across all US payers. "These agreements provide a sustainable and stable access framework to important medicines for people living with rare diseases and serious conditions," said Diego Sacristan, CSL's chief commercial officer.

The deals arrive despite organised resistance from smaller biotechnology companies. Ten US biotechs formed the Midsized Biotech Alliance of America in February, arguing that companies reliant on a single marketed product targeting niche patient populations are less equipped than resource-rich large pharmaceutical groups to absorb the financial impact of MFN pricing.