Trump administration announces first ‘most-favored nation’ drug pricing deal with Pfizer

On September 30, 2025, the White House announced a first-of-its-kind agreement with Pfizer to bring “most-favored nation” (MFN) pricing to US patients. The deal is presented as part of President Donald Trump’s broader effort to reduce prescription drug costs and address what the administration has termed “global freeloading” in pharmaceutical markets. More than 100 million patients are claimed to be affected by the conditions treated with Pfizer’s medicines.

According to the White House fact sheet, the agreement ensures that all Pfizer medicines will be available to Medicaid programs at the lowest net prices offered by the company in other developed countries. This MFN benchmark is intended to provide US public payers with parity to the prices achieved by other advanced economies. As noted, it is not yet clear exactly which countries are included. The Centers for Medicare & Medicaid Services (CMS) defines the MFN price as the lowest rate in an OECD country with a GDP per capita of at least 60% of the US level, which could encompass markets from Germany, Canada and the UK to Italy, Spain, South Korea and Japan, depending on how GDP is measured.

Alongside this agreement, Pfizer will begin offering direct-to-consumer sales through a new federal platform, TrumpRx, at substantial discounts from list prices. The White House highlighted specific examples:

• Eucrisa (crisaborole), a topical treatment for atopic dermatitis, will be discounted by 80%.
• Xeljanz (tofacitinib), an oral therapy for rheumatoid arthritis and other inflammatory conditions, will be discounted by 40%.
• Zavzpret (zavegepant), a nasal spray for acute migraine, will be discounted by 50%.

The administration also stated that Pfizer will “repatriate” revenue generated abroad from existing products to benefit US patients.

In exchange for adopting MFN pricing, The Washington Post reports the agreement includes a package of incentives. Pfizer will reportedly receive a 3-year exemption from tariffs on pharmaceutical imports and has committed to invest $70 billion in US research, development, and manufacturing during this period.

In its own press release, Pfizer said the agreement would cover most of its primary care treatments and selected specialty brands, with savings of up to 85% and an average reduction of around 50%. While the full terms remain confidential, the company described the deal as offering long-sought “certainty and stability” on tariffs and pricing, which it argued had weighed down sector valuations. Pfizer said the arrangement would allow it to expand investment in the US and presented it as part of a “balanced global pricing approach” that seeks to recognize the value of innovation while keeping prices in the US and other developed markets both reasonable and sustainable.

The deal builds on a May 2025 executive order directing the Department of Health and Human Services to pursue MFN pricing, followed by letters sent to manufacturers in July 2025 urging them to adopt similar terms. The White House indicated that further agreements with other companies are under negotiation.

This marks the first time a US administration has secured a voluntary MFN pricing arrangement with a pharmaceutical manufacturer. The Trump administration has framed the initiative as a step toward ensuring American patients and taxpayers do not pay higher prices than those negotiated by other countries’ health systems.

Industry group the Pharmaceutical Research and Manufacturers of America (PhRMA) also issued a statement this week outlining steps its members are taking, including a pledge of $500 billion in planned US investment over the next decade, expanded financial assistance for patients, and the launch of a new website, AmericasMedicines.com, to highlight direct-to-patient purchasing options. In its statement, the association called on “policymakers to protect innovation, fix the broken insurance system that burdens patients with high out-of-pocket costs, and ensure foreign governments pay their fair share.”

At a White House press conference announcing the move, President Trump reiterated that the US is “done subsidizing the healthcare of the rest of the world,” and flagged that the tariff threat helped bring Pfizer to the table. He added that other drug manufacturers are expected to announce similar arrangements.

Attention now turns to what comes next. Will additional companies follow Pfizer’s lead, and could the administration seek to move from voluntary deals to binding requirements? In the coming days, speculation and discussion are likely to intensify, with observers watching closely for further agreements, clarification of pricing formulas, and whether the promised discounts actually translate into meaningful cost relief for patients. The agreement may also carry global ripple effects, as companies could adjust their pricing strategies outside the US – potentially altering list prices, reimbursement negotiations, or launch timing in other developed markets.