Drug Prices in 2026: How New Healthcare Policies Could Change Pharmaceutical Access

Drug pricing in the U.S. is entering a new phase in 2026.

The biggest change is no longer only about whether medicines are expensive. It is about who sets the price, how manufacturers respond, how payers reimburse medicines, and whether patients can actually access lower prices.

The implementation of Medicare’s negotiated prices, expansion of federal drug-price negotiations, Most-Favored-Nation (MFN) pricing initiatives, direct-to-patient purchasing models, Medicaid pricing changes, and growing pressure on pharmaceutical manufacturers are reshaping the commercial environment.

For pharmaceutical companies, this means pricing strategy can no longer be separated from market access, government policy, manufacturing location, contracting, patient affordability, and portfolio planning.

For payers, providers, investors, pharmacies, distributors, and healthcare companies, the bigger question is:

How will changing drug-pricing policies affect revenue, access, competition, and future pharmaceutical launches?

2026 Is a Turning Point for U.S. Drug Pricing

The first major milestone is the implementation of Medicare’s negotiated Maximum Fair Prices (MFPs).

The first 10 negotiated Medicare Part D drug prices became effective on January 1, 2026. CMS says the negotiated prices represent discounts of 38% to 79% from list prices. If these prices had been in effect in 2023, Medicare estimates that they would have reduced spending on the selected medicines by about $6 billion, or 22%, while Medicare beneficiaries were expected to save approximately $1.5 billion in out-of-pocket costs in 2026. About 9 million Medicare beneficiaries use at least one of the 10 selected medicines.

This changes the commercial equation for manufacturers.

The issue is no longer simply:

What price can a manufacturer charge?

It increasingly becomes:

What price can a manufacturer sustain across Medicare, commercial insurance, Medicaid, direct-to-consumer channels, and international markets while protecting access and profitability?

The 10 Drugs That Started the Negotiation Era

The first Medicare negotiation cycle included major medicines such as:

• Eliquis from Bristol Myers Squibb and Pfizer
• Jardiance from Boehringer Ingelheim and Eli Lilly
• Xarelto from Johnson & Johnson
• Januvia from Merck
• Farxiga from AstraZeneca
• Entresto from Novartis
• Enbrel from Amgen
• Imbruvica from AbbVie and Johnson & Johnson
• Stelara from Johnson & Johnson
• Fiasp and NovoLog from Novo Nordisk

The commercial importance of these products extends well beyond the individual medicines.

These are established, high-spend products with large patient populations, significant payer exposure, and important positions within chronic disease and specialty-care portfolios.

Their negotiated prices therefore create a precedent for how manufacturers evaluate the future lifecycle of high-value medicines.

Medicare Negotiation Is Expanding

The policy impact does not stop with the first 10 medicines.

CMS has already negotiated prices for a second group of 15 drugs, with those MFPs scheduled to become effective on January 1, 2027. CMS reported that these medicines accounted for approximately $42.5 billion in gross covered Part D prescription spending in 2024, representing about 15% of total gross covered Part D spending. About 5.3 million Medicare Part D beneficiaries used these medicines during that period.

The third negotiation cycle is even broader.

In January 2026, CMS selected 15 additional high-cost medicines covered under Medicare Part B and Part D, plus one previously negotiated medicine for renegotiation. The resulting prices are scheduled to take effect on January 1, 2028.

This creates a longer-term planning issue for pharmaceutical companies.

A medicine entering a high-revenue period today may face a very different pricing environment several years later.

What pharmaceutical companies need to track

Manufacturers increasingly need visibility into:

• Medicare negotiation eligibility
• Gross and net pricing
• Patent and exclusivity timelines
• Biosimilar and generic competition
• Part B versus Part D exposure
• Medicaid rebate implications
• PBM and payer contracting
• Patient affordability programs
• International reference pricing
• Manufacturing and supply-chain costs
• Portfolio cannibalization
• Launch sequencing
• Lifecycle-management opportunities

This is where drug-pricing intelligence becomes commercially important.

Most-Favored-Nation Pricing Adds Another Layer

Medicare negotiation is only one component of the 2026 pricing environment.

The Trump administration has also pursued a Most-Favored-Nation pricing strategy, which seeks to align U.S. medicine prices with prices paid in other developed countries.

The White House said in May 2026 that the administration had reached voluntary MFN pricing agreements with 17 of the largest pharmaceutical manufacturers.

The administration subsequently said these agreements covered companies representing approximately 86% of the U.S. branded pharmaceutical market.

However, the commercial impact will not be identical across every manufacturer or product.

The precise terms, eligible medicines, implementation mechanisms, patient channels, and international implications can vary.

For pharmaceutical executives, the important question is therefore not simply whether an MFN agreement exists.

It is:

Which products, patient segments, channels, and geographies are affected?

Pfizer Shows How Manufacturers Are Responding

Pfizer provides one of the clearest examples of how manufacturers are adapting.

In February 2026, Pfizer launched a program through TrumpRx offering significant discounts on more than 30 medicines. Pfizer said the program formed part of its broader MFN agreement with the U.S. government and was intended to improve affordability and access for millions of Americans.

Pfizer CEO Albert Bourla has also been directly involved in the company’s U.S. government pricing agreement.

The strategic implication is significant.

Pharmaceutical companies are increasingly considering direct purchasing, patient affordability, government agreements, and alternative access channels alongside traditional payer and PBM relationships.

That could influence how manufacturers design commercial models for future launches.

AstraZeneca Connects Pricing With U.S. Manufacturing

AstraZeneca has taken another approach.

In October 2025, AstraZeneca announced an agreement with the U.S. government involving lower medicine costs, direct-to-consumer sales through TrumpRx, and a commitment to invest $50 billion in U.S. manufacturing and R&D over five years. The company said it planned to move toward making all medicines sold in the U.S. domestically.

CEO Pascal Soriot has therefore become an important executive to watch in the relationship between drug pricing, manufacturing localization, tariffs, and pharmaceutical investment.

This illustrates an important 2026 trend:

Drug pricing policy is increasingly connected to industrial policy.

Pricing concessions may be linked with manufacturing investment, supply-chain localization, tariff arrangements, and domestic production capacity.

For CDMOs, CMOs, API manufacturers, packaging companies, and pharmaceutical supply-chain providers, this creates new opportunities as well as new competitive pressures.

Eli Lilly Shows Why Patient Access Is Becoming a Commercial Strategy

Eli Lilly and Company is another important company to monitor.

Lilly’s 2026 affordability strategy includes LillyDirect, direct-to-patient purchasing pathways, employer programs, and work with government programs.

Lilly says Medicaid and dual-eligible populations face significant affordability challenges and notes that, under its November 2025 U.S. government agreement, states can expand Medicaid access to its obesity medicines at Medicare-equivalent price points, with reduced prices available beginning in May 2026.

Lilly’s approach demonstrates that access strategy is moving beyond conventional pricing negotiations.

It increasingly involves:

pricing + coverage + distribution + digital access + patient support.

For companies competing in obesity, diabetes, cardiometabolic disease, oncology, and other high-value therapeutic areas, these access models could become increasingly important.

What About Merck and Other High-Value Portfolios?

Merck & Co. illustrates another dimension of the pricing challenge: portfolio concentration.

Merck reported $16.6 billion in worldwide sales in Q2 2026, including $8.4 billion from KEYTRUDA and KEYTRUDA QLEX.

Its regulatory filings also identify government price-setting under the Medicare program as an important factor affecting the pharmaceutical business environment.

For large pharmaceutical companies, pricing policy therefore cannot be viewed as a standalone reimbursement issue.

It can affect:

• Revenue concentration
• Forecasting
• Portfolio diversification
• Lifecycle management
• Indication expansion
• M&A decisions
• R&D allocation
• Launch pricing
• Investor expectations

The People Driving the Drug-Pricing Debate

The drug-pricing environment in 2026 is being shaped by government leaders as well as pharmaceutical executives.

Donald Trump

President Donald Trump has made lower prescription drug prices and MFN pricing a central part of his healthcare policy agenda. His administration has pursued voluntary agreements with major pharmaceutical manufacturers and has pushed manufacturers toward lower U.S. prices.

Robert F. Kennedy Jr.

As HHS Secretary, Robert F. Kennedy Jr. is involved in implementing the administration’s broader healthcare and drug-affordability agenda. HHS has stated that the administration expects manufacturers to align U.S. pricing for certain branded medicines with lower prices charged in comparable countries.

Mehmet Oz, MD

Mehmet Oz, CMS Administrator, is directly involved in Medicare payment and drug-pricing implementation.

CMS has positioned the Medicare negotiation program as a major mechanism for reducing spending for beneficiaries and taxpayers.

Albert Bourla

As Pfizer’s CEO, Albert Bourla has been directly involved in Pfizer’s agreement with the U.S. government and the company’s strategy for lower-cost access to medicines.

Pascal Soriot

AstraZeneca CEO Pascal Soriot has also been directly involved in the company’s U.S. pricing and manufacturing commitments.

David Ricks

David A. Ricks, Lilly’s chair and CEO, is another executive to watch as obesity medicines, direct-to-patient access, manufacturing investment, and government pricing policies converge.

Will Lower Prices Automatically Mean Better Pharmaceutical Access?

Not necessarily.

Lower prices can improve affordability, but pharmaceutical access depends on more than the manufacturer’s price.

Patients can still face:

• Insurance coverage restrictions
• Prior authorization
• Formulary exclusions
• High deductibles
• Coinsurance
• Pharmacy availability
• Distribution limitations
• Provider prescribing decisions
• Supply shortages
• Eligibility requirements for assistance programs

That is why net access is a more useful commercial concept than list-price reduction alone.

A medicine can have a lower negotiated price and still remain difficult for some patients to obtain.

For manufacturers and healthcare organizations, measuring access therefore requires analysis across the complete patient journey.

The Impact on Pharmaceutical Manufacturers

The 2026 pricing environment could reshape how companies build their portfolios.

1. Launch pricing will become more strategic

Companies may need to model not only the initial launch price but also future government negotiations, payer discounts, rebates, competition, and international reference pricing.

2. Patent strategy becomes more valuable

Patent duration and exclusivity can influence the period during which a manufacturer can capture premium pricing before generic or biosimilar competition emerges.

3. Lifecycle management becomes critical

New indications, formulations, combinations, delivery technologies, and patient populations may become more important as companies seek to extend the commercial value of established products.

4. Manufacturing location can influence pricing strategy

AstraZeneca’s U.S. investment demonstrates how manufacturing localization can become linked with government policy and commercial strategy.

5. Direct-to-patient models could expand

Pfizer and Lilly demonstrate that manufacturers are experimenting with alternative pathways for improving patient access and affordability.

What This Means for Investors

Investors should look beyond headline revenue growth.

Drug-pricing policy can influence:

• Revenue durability
• Price-volume assumptions
• Gross-to-net exposure
• Medicare dependence
• Portfolio concentration
• R&D returns
• Manufacturing investment
• M&A attractiveness
• Patent cliffs
• Competitive positioning

A pharmaceutical asset with strong clinical performance may not have the same commercial outlook if reimbursement pressure significantly changes its future net price.

This makes policy-adjusted commercial forecasting increasingly important.

What This Means for Payers and Healthcare Providers

For payers, lower negotiated prices can create opportunities to reduce spending, but formulary strategy and utilization management remain important.

For providers, particularly those administering Part B medicines, reimbursement changes can influence treatment economics, site-of-care decisions, and prescribing behavior.

Hospitals and health systems should therefore monitor both the negotiated price and the broader reimbursement structure surrounding each medicine.

What This Means for CDMOs, Suppliers and Healthcare Technology Companies

Drug-pricing reforms also create indirect opportunities outside pharmaceutical manufacturers.

CDMOs and CMOs may see increased demand for:

• U.S.-based manufacturing
• Flexible production capacity
• Cost-efficient manufacturing
• API localization
• Fill-finish services
• Specialty drug production
• Supply-chain resilience

Healthcare technology companies can also benefit from growing demand for:

• Price transparency
• Patient affordability platforms
• Benefit verification
• Prior-authorization automation
• Specialty pharmacy technology
• Reimbursement analytics
• Payer intelligence
• Patient-support platforms

The opportunity is therefore much broader than drug manufacturers alone.

The Strategic Questions Companies Should Be Asking in 2026

Healthcare executives should be asking:

Which products could be exposed to future Medicare negotiation?

How could MFN pricing affect U.S. and international price architecture?

Which competitors are offering direct-to-patient access?

How will government pricing affect launch strategy?

Which products have the greatest patent and exclusivity risk?

Where should pharmaceutical manufacturing capacity be located?

How could Medicaid policy affect obesity and chronic-disease drug access?

Which therapeutic areas are most exposed to government pricing pressure?

How could lower prices change patient adoption and treatment volumes?

These are commercial questions, not simply policy questions.

How Towards Healthcare Research & Consulting Can Help

For pharmaceutical, biotech, healthcare, payer, CDMO, investor, and healthcare-technology organizations, the value is not simply knowing that drug-pricing policy is changing.

The value comes from understanding what the change means for a specific company, product, competitor, patient segment, and geography.

Towards Healthcare Research & Consulting can support decision-makers with focused intelligence across:

Drug Pricing Intelligence

Track list prices, negotiated prices, reimbursement changes, discount structures, government policies, payer dynamics, and competitive pricing movements.

Policy and Regulatory Intelligence

Monitor CMS, HHS, FDA, Medicare, Medicaid, MFN initiatives, government negotiations, policy proposals, and implementation timelines.

Competitive Intelligence

Benchmark how companies such as Pfizer, Eli Lilly, Merck, AstraZeneca, Novo Nordisk, Johnson & Johnson, Bristol Myers Squibb, AbbVie, Amgen, Novartis, and other manufacturers are responding.

Market Access Intelligence

Assess payer coverage, patient affordability, reimbursement barriers, formulary dynamics, specialty pharmacy channels, and access pathways.

Pipeline and Portfolio Intelligence

Evaluate how pricing pressure could affect clinical development, indication expansion, lifecycle management, patent strategy, and portfolio prioritization.

Commercial and GTM Strategy

Identify the most attractive patient segments, payer channels, geographic opportunities, distribution models, and commercialization pathways.

Manufacturing and Supply-Chain Intelligence

Assess U.S. manufacturing investments, API sourcing, CDMO opportunities, localization strategies, capacity expansion, and supply-chain risks.

Executive and Investor Intelligence

Build company-specific assessments covering revenue exposure, pricing risks, competitive positioning, policy exposure, pipeline strength, and future growth opportunities.

Why This Matters for 2026 and Beyond

The U.S. pharmaceutical industry is moving from a system primarily shaped by manufacturers, insurers, PBMs, and market competition toward a more complex model in which government negotiation, international price comparisons, direct purchasing, Medicaid policy, manufacturing strategy, and patient affordability increasingly interact.

The first 10 Medicare-negotiated medicines are already experiencing the new pricing environment in 2026. Another 15 medicines are scheduled for negotiated prices in 2027, while the third cycle introduces additional Part B and Part D products for 2028.

At the same time, 17 major pharmaceutical manufacturers have entered voluntary MFN agreements with the U.S. government, according to the White House.

For pharmaceutical executives, investors, payers, healthcare providers, CDMOs, distributors, and technology companies, this means one thing:

Drug pricing is becoming a strategic business issue across the entire healthcare ecosystem.

Organizations that understand the policy changes early can better anticipate pricing exposure, competitive shifts, access opportunities, and investment priorities.

How Towards Healthcare Can Turn Pricing Changes Into Business Intelligence

Payal Rabde and the Towards Healthcare team can help organizations translate drug-pricing developments into actionable commercial intelligence — from competitor tracking and policy monitoring to market access, portfolio, pipeline, pricing, and GTM strategy.

If your organization needs to understand which pharmaceutical products, companies, therapeutic areas, or patient segments are most exposed to the 2026 drug-pricing transformation, Towards Healthcare Research & Consulting can develop a focused intelligence assessment around your business priorities.

Frequently Asked Questions

What is changing in U.S. drug pricing in 2026?

Medicare’s first negotiated Maximum Fair Prices took effect on January 1, 2026, while the U.S. government is also pursuing MFN pricing agreements and additional Medicare negotiations.

How much can Medicare-negotiated prices reduce drug costs?

CMS reported negotiated discounts of 38% to 79% from list prices for the first 10 medicines. CMS estimated that the prices could have reduced Medicare spending by about $6 billion based on 2023 spending.

Which pharmaceutical companies are most affected?

Companies with high-spend medicines covered by Medicare negotiations face direct exposure. Pfizer, Eli Lilly, Merck, AstraZeneca, Johnson & Johnson, Bristol Myers Squibb, Novo Nordisk, AbbVie, Amgen, and Novartis are among the companies relevant to the evolving pricing environment.

Will drug prices fall for everyone?

Not necessarily. Government-negotiated prices primarily affect eligible Medicare products and populations, while MFN agreements and direct-to-patient programs have their own eligibility and implementation structures.

How could drug-pricing policies affect pharmaceutical companies?

They can influence pricing strategy, revenue forecasts, payer negotiations, product lifecycle management, R&D priorities, manufacturing decisions, portfolio strategy, and market access.

What should investors monitor?

Investors should monitor Medicare negotiation exposure, MFN agreements, patent cliffs, competitive launches, gross-to-net changes, payer dynamics, manufacturing investments, and portfolio concentration.

How can Towards Healthcare help pharmaceutical companies?

Towards Healthcare Research & Consulting can provide drug-pricing intelligence, policy monitoring, competitive intelligence, market-access analysis, pipeline tracking, company benchmarking, commercial strategy, and customized decision-support intelligence.

Final Takeaway

In 2026, drug pricing is no longer just a pricing issue. It is a pharmaceutical strategy issue.

The companies that respond effectively will be those that understand how policy, pricing, reimbursement, competition, manufacturing, patient access, and innovation are connected.

For decision-makers, the competitive advantage will come from identifying these changes before they affect revenue, access, and portfolio decisions.

Towards Healthcare Research & Consulting can help turn these policy shifts into actionable intelligence for smarter healthcare decisions.