The Week in Review in Prescription Drug Pricing: Bad Week for Pharma in Court, Potential Drugmaker Deals Coming Soon, and more
Bad Week for Pharma in Court!
Big Pharma suffered two more courtroom defeats this week, delivering the 24th and 25th legal victories for Medicare negotiation and the patients who fought to make it law. On Wednesday, a unanimous Fifth Circuit panel rejected a challenge from PhRMA, the industry’s trade association and a central player in its years-long campaign to dismantle negotiation. Two days earlier, Merck — the first drugmaker to file a lawsuit after Medicare negotiation became law in 2022 — lost its challenge in federal court in D.C. The losses add to an increasingly decisive legal record: courts have repeatedly rejected the industry’s attempts to overturn Medicare negotiation, and the Supreme Court declined to hear six additional drugmaker challenges earlier this year. Big Pharma has spent years and millions of dollars trying to protect its monopoly pricing power in court, but patients and Medicare negotiation keep winning. — [Merck Brief, PhRMA Brief, The Hill, Fierce Pharma, Bloomberg Law, Endpoints News, Law360]
Potential Drugmaker Deals Coming Soon
The White House is expected to announce a new round of most-favored-nation agreements with midsized biotech companies on Monday. According to reporting, participating drugmakers would offer discounts to state Medicaid programs based on prices paid abroad, in exchange for exemptions from forthcoming Medicare drug pricing models and, in some cases, potential tariff relief. Lower prices are welcome, but most of these discounts would flow to Medicaid programs that already receive substantial mandatory discounts, and participation would be optional for states — raising questions about how much additional savings the agreements will deliver. It’s also unclear whether the savings generated by these agreements will outweigh any savings forgone by exempting participating drugs from the forthcoming Medicare pricing models. Like other administration drug initiatives, these agreements could provide meaningful savings in some circumstances, but enforcement mechanisms are unclear and even in a best case scenario, they fall short of the transparent, system-wide reforms needed to bring down U.S. drug prices for patients across the market. — [Bloomberg, POLITICO]
ICYMI: A growing number of U.S. employers are planning to drop coverage of GLP-1 weight-loss drugs in 2027 as healthcare costs continue to rise. The share of employers covering GLP-1s for obesity fell from 72% in 2025 to 60% in 2026, while 14% said they already have or plan to eliminate coverage in 2027. As the high price of these medicines puts increasing pressure on employer health plans — the most common way that Americans have medical insurance — patients risk losing access to treatments that can significantly improve their health. — [Reuters]
New Video: Your Voice Is Your Power
In honor of National Patient Advocacy Day on Wednesday, P4AD released a new video, Your Voice Is Your Power, following patient advocates Kris Garcia, Sarah Wisniewski, and Amelia Schachter as they travel to Capitol Hill to share their experiences with high prescription drug costs directly with lawmakers. None of them set out to become advocates — their experiences struggling to access and afford the medicines they need compelled them to speak up. As Kris says in the video, “They might have all that money, but we have our stories.” Their experiences are a powerful reminder that while the pharmaceutical industry has enormous resources and influence, patients have the power to change policy by making their voices heard. Watch and share the full video here. — [P4AD]
Drug Prices Fall as IRA Reforms Take Hold
Prescription drug prices fell 0.8% in July and 3.1% over the past year — the steepest year-over-year decline since 1963. While that’s encouraging news, the CPI measures what pharmacies receive from insurers and consumers rather than what patients pay out of pocket, meaning millions of Americans are still facing unaffordable costs at the pharmacy counter. The Trump administration has credited TrumpRx and its most-favored-nation agreements for the decline, but the general consensus from drug pricing experts is that the evidence points elsewhere. The administration’s GLOBE and GUARD MFN models have not yet taken effect, and the impact of TrumpRx on the index remains unclear given the paucity of data. In terms of robust policy measures, this is the first year that lower prices negotiated under the Inflation Reduction Act are in effect for some of Medicare’s highest-spending drugs. Further, the law’s inflation rebates are designed to discourage excessive pharma price hikes, while growing generic and biosimilar competition is beginning to bring down prices for some blockbuster drugs. No single policy can explain the entire decline, but the data is a promising sign that reforms designed to rein in drug prices and increase competition are working. The answer now is to build on that progress — not weaken the policies helping deliver it. — [PBS, Endpoints News, U.S. Bureau of Labor Statistics]
Another Legal Win for Medicare Negotiation
The pharmaceutical industry suffered another legal defeat this week after the D.C. Circuit rejected Teva Pharmaceuticals’ core challenges to Medicare drug price negotiation. The court upheld CMS’s decision to treat Austedo and Austedo XR as a single drug for negotiation and rejected Teva’s constitutional claim that the program deprived the company of a protected property interest. One narrow issue involving when generic competition is sufficient to exclude a drug from negotiation was sent back to the lower court for consideration. P4AD filed an amicus brief in the case defending the program and bringing patient voices directly into the appeal. Coming just three months after the Supreme Court declined to hear six additional industry challenges, the decision adds to the overwhelming body of rulings rejecting Big Pharma’s years-long campaign to dismantle a program that is already lowering prices for patients. — [Bloomberg, Fierce Pharma, P4AD]
Big Pharma’s Banner Year Continues
According to Protect Our Care, ten of the top publicly traded drugmakers brought in nearly $300 billion in global revenue during the first half of 2026 — $24 billion more than during the same period last year — while returning $63 billion to shareholders through dividends and stock buybacks. Meanwhile, nearly 6 in 10 Americans say they are worried about being able to afford their prescription drugs. The contrast is stark: the pharmaceutical industry continues to generate enormous revenues while millions of patients ration medications, leave prescriptions unfilled, or sacrifice other necessities to afford them. Big Pharma has the ample resources to invest in research and develop the treatments patients are waiting for without charging Americans an average of four to eight times what they charge in other high-income nations for the very same brand-name drugs.
TrumpRx, 6 Months In
Six months after the TrumpRx platform launched, we’re getting a clearer picture of who the program is helping — and its limitations. The administration now suggests Americans have saved more than $700 million through TrumpRx and its broader most-favored-nation efforts, but has not yet released data to verify that figure.GoodRx, the primary technology partner for TrumpRx, reports that consumer demand via TrumpRx has so far been concentrated in weight-loss drugs, largely expanding access to new patients rather than shifting existing demand, with no material impact on its overall business. The feedback we’ve heard directly from patients in our community also points to significant limitations. In a P4AD survey conducted earlier this year, respondents frequently reported finding their medications listed on TrumpRx but being unable to use the discount, finding a lower price through their insurance or elsewhere, or still being unable to afford the discounted cash price. One patient told us, “TrumpRx offered the same deal available on the drug manufacturer’s website for people who pay out of pocket. That price is still too high for me.” TrumpRx may provide meaningful savings for some patients, but six months in, the available evidence reinforces the key distinction between offering another pathway to consumer discounts and taking steps to lower the prices of prescription drugs. TrumpRx cannot substitute for structural reforms that rein in drugmakers’ pricing power and reduce prices across the system. — [POLITICO, Fox Business, GoodRx]
P4AD Takes the Stage at Latino Health Summit
Yesterday, P4AD CEO Merith Basey alongside We Are Más founder Evelyn Pérez-Verdía presented at the Latino Health Summit on how high prescription drug prices are uniquely impacting Latino communities. The presentation highlighted how unaffordable medicines can lead to delayed care, skipped prescriptions, and difficult financial tradeoffs for families already facing disproportionate rates of chronic disease. Merith and Evelyn also discussed how deeper investment in and collaboration with Latino communities can help identify information gaps and combat disinformation around drug pricing and health care reforms.
Four Years of Historic Prescription Drug Price Reforms
Sunday marks four years since the Inflation Reduction Act was signed into law, delivering the most significant health care reforms in decades. Four years later, patients are experiencing the results: people on Medicare have a $2,100 annual out-of-pocket cap for their medications, a $35 monthly insulin cap, free recommended vaccines, and the first Medicare-negotiated drug prices have begun to save patients and taxpayers money this year, with additional rounds of negotiation underway. Negotiation and implementation of lower prices have now continued over two different administrations without interruption. This has culminated in the record sharpest drop in drug prices in more than 60 years, which experts attribute in large part to the Inflation Reduction Act. For patients like Rhonda of Conroe, Texas, whose husband takes Xarelto, these reforms have changed what it means to afford essential medication. Before the IRA, she says her husband would lose coverage for Xarelto near the end of each year and have to ask his doctor for samples to make it to January. “Very glad he can get the medication that he needs now,” Rhonda told us. At the same time, the pharmaceutical industry remains highly profitable, R&D investment continues, price hikes continue even with the IRA inflation rebates, and the biopharma market is seeing a surge in dealmaking — undermining years of industry lobbying spending and fearmongering that these reforms would come at the expense of innovation. The IRA proved that Congress can take on Big Pharma and lower drug prices without sacrificing the development of new treatments, but there’s still much more to be done. Now, lawmakers should build on that progress by expanding Medicare negotiation, increasing competition, and tackling the high launch prices that continue to put new medicines out of reach. — [P4AD, Endpoints]
Background: 67-year-old retired librarian from Lebanon, Kentucky
Condition: Type 1 Diabetes and Polyneuropathy
Drug: Lispro ($639.59 / vial), Lantus ($649.75 / vial), Midodrine ($185.99). Kaye pays $35 per vial for Lispro and Lantus, and Midodrine is covered by her insurance.
In her words:
“Even with good insurance coverage, prescription drug prices are still ridiculously high for patients who need them. A minor change in my insurance could leave me with soaring out-of-pocket costs.”
“I believe in lower prescription drug prices because I am way too tired to have to continue asking this question: How many people have to continue to die because they can’t afford their insulin and inhalers?”
Closed-Door Policy Change Exempted Blockbuster AbbVie Drug from Negotiations
An unnoticed CMS policy change delayed Medicare price negotiation for AbbVie’s blockbuster drug Creon for an additional seven years — despite Creon, a pancreatic enzyme replacement therapy, accounting for higher Medicare spending than six other drugs chosen in the third round of negotiations. Brought to light by a new Public Citizen analysis, the revised CMS guidance pertains to drugs that were initially designated as small molecule drugs, but later reclassified as biologics. The switch effectively restarted their eligibility timeline for negotiation, although the interpretation of the policy was not publicly debated and runs counter to the intent of the Medicare negotiation program, allowing drugs to effectively bypass negotiation despite having profits far higher than other drugs selected instead. As Public Citizen noted, 185,000 Medicare beneficiaries used Creon in 2024 at a cost of $1.49 billion to Medicare, while the drug selected for negotiation instead, Amgen’s Otezla, accounted for $1.05 billion over the same period and was used by only 31,000 beneficiaries. — [Public Citizen, STAT News]
Most-Favored-Nation Pricing Could Save Medicare Nearly $200 Billion
AARP’s new report found that applying most-favored-nation pricing to 10 high cost drugs could reduce Medicare spending by nearly $200 billion between 2029 and 2033. These 10 drugs have not yet been selected for Medicare negotiation, and only one will be eligible in 2027 — despite accounting for nearly $50 billion in annual Medicare spending in 2025 and being used by more than 3 million people on Medicare. AARP’s analysis suggests that a well-designed MFN-style policy could serve as an additional tool to strengthen Medicare drug price negotiation and lower costs for patients. — [AARP]
New Analysis Confirms: ORPHAN Cures is an Unnecessary Pharma Giveaway
A new analysis finds that orphan drugs recover their clinical trial costs at a comparable rate to other drugs — undercutting industry arguments for the ORPHAN Cures Act. The provision created a carveout in the Medicare Negotiation Program, shielding some blockbuster orphan drugs, like the top-selling cancer medicine Keytruda, from negotiation at an estimated cost to Medicare of $8.8 billion. The policy also postponed negotiation for orphan disease treatments that receive an approval for a non-rare condition. P4AD has long argued that this exemption is unnecessary since Medicare negotiation already exempted single-indication orphan drugs. Congress should be strengthening the Medicare negotiation program, and resisting industry pressure for similar unnecessary carveouts via policies like GLOBE and GUARD. Patients continue to urge lawmakers to repeal ORPHAN Cures and block further pharma-backed carveouts like EPIC and MINI that would keep prices high for longer. — [Health Affairs, STAT News, CBO, Congress, BioSpace, Endpoints, STAT News]
Patient Advocate Spotlight: Susan Vigen
Condition: Severe overactive bladder and interstitial cystitis
Drugs: Myrbetriq (Listed at $1,677 / 90 day supply)
Background: Patient advocate from South Carolina
In Her Words: “Myrbetriq has a monthly copay responsibility for me that increased from $120 to $365 every 90 days starting in the fall of 2024. This is simply too expensive for me and while there is a generic version of the drug called Mirabegron, my insurance will not cover it. Thus, I am left constantly looking for cheaper pharmacies and ways to save.”
“As someone who used to work in the pharmaceutical industry for about 17 years on the data management side, I understand the cost of bringing a drug to market and the need for some profit making to be made, however, I am now the patient feeling the financial frustration.”
Xeljanz to be Removed from Negotiations
CMS announced that Xeljanz and Xeljanz XR will be removed from the Medicare Drug Price Negotiation Program in 2029 after determining the drugs will soon face generic competition. While Xeljanz was included in the third round of Medicare negotiations, the lower negotiated prices which will be announced in November 2026 will only be in effect for one year, beginning on January 1 2028. Medicare negotiation is designed to target high-cost, single-source drugs that lack competition. Once meaningful competition enters the market, those drugs are no longer eligible for negotiation — reflecting the program’s role as a strong counterweight to monopoly pricing, not a replacement for competition. While it is too soon to know the impact the new competitor will have on overall prices, increased generic or biosimilar entry has historically driven significant savings for patients, and one generic coming to market lowers prices by an average of 39%. — [FDA]
Trump to End Medicare Drug Premium Subsidies
For years, the pharmaceutical industry claimed that Medicare drug price reforms would drive higher premiums for patients. Now, the Trump administration is ending a program specifically designed to keep those premiums down. A primary driver of high premiums is the high cost of prescription drugs, forcing people with Medicare to effectively subsidize pharma profits. Instead of shifting more costs onto patients, policymakers should focus on lowering the prices drug companies are allowed to charge. — [WSJ, NYT, USA Today, Common Dreams]
New Pharmaceutical Tariffs Take Effect
President Trump’s Section 232 tariffs on patented pharmaceutical products and their ingredients took effect today, imposing rates of up to 100% under a national security justification. While companies with approved onshoring plans or most-favored-nation (MFN) agreements may face lower rates, and generics are currently exempt, those exemptions could change within a year, and generics are also being threatened by new tariffs announced earlier this month. Given that only 10% of active pharmaceutical ingredients (APIs) used in U.S medicines are produced domestically, these tariffs are likely to have widespread impacts across the supply chain. Tariffs do nothing to address the root cause of high drug prices. Instead, they increase the risk of drug shortages and drive higher costs for patients, as manufacturers are unlikely to absorb additional expenses. Any potential benefits from reshoring will likely take years to materialize, while price increases will be felt almost immediately as costs to American patients are already escalating when it comes to healthcare. — [White House]
Patient Advocate Spotlight: Emmabella Rudd
Background: Florida State University student, documentary producer, and insulin accessibility advocate since her diagnosis at 5 years old.
Condition: Type 1 Diabetes
Drug: Insulin ($3,000 per year)
In her words:
“It’s frustrating to see pharmaceutical companies bask in the protection of numerous patents around their insulin products. They’re interested in appearing concerned about drug affordability, but their efforts are always superficial and short-lived. Drug companies need to remember that their actions affect real human lives, and at the end of the day, the people will have the power.”
Welcome to the Week in Review.
House & Senate Markups Advance Drug Pricing Reform
With two markups this week, the House E&C and Senate HELP Committees advanced three bipartisan, P4ADNow-supported drug pricing reforms. The Senate’s INSULIN Act (S. 4189) would establish a $35 monthly out-of-pocket cap for people with private insurance, and crack down on Big Pharma’s abuse of citizen petitions. In the House, the Stop GAMES Act (H.R. 8908) similarly targets citizen petitions, while the Biosimilar Red Tape Elimination Act (H.R. 5526) would streamline FDA requirements on interchangeability — cutting unnecessary regulatory red tape that delays lower-cost biosimilars from coming to market. The Senate version of the Biosimilar Red Tape Elimination Act has also already passed favorably out of committee. Driven in part by sustained advocacy from the P4ADNow community, these bills advancing out of committee keep them in play for potential inclusion in broader legislative packages later this year. If enacted, these reforms would lower out-of-pocket costs for patients, curb pharmaceutical industry tactics that delay competition, and help bring more affordable alternatives to market. — [P4ADNow, P4ADNow, POLITICO, The Hill, POLITICO]
Big Pharma Leads 2026 Health Lobbying
Mid-year lobbying disclosures show the pharmaceutical industry once again dominating Washington, accounting for 42 of the top 100 lobbying spenders. PhRMA alone has spent nearly $20 million so far this year — more than $6 million ahead of the next highest spender — with major drugmakers Eli Lilly, Merck, Pfizer, and Johnson & Johnson also among the top ranks. Even in a relatively unproductive Congress, the pharmaceutical industry’s lobbying remains near record levels, underscoring the scale of its power. With roughly three pharma lobbyists per member of Congress, organizations like P4AD play a critical role as an independent counterweight — elevating patient voices without the influence of industry funding and pushing back against pharma-driven narratives. — [Washington Post, POLITICO]
P4AD Warns Against President Trump’s Generic Tariffs Plan
On Tuesday, President Trump announced his plans to instate a 100% tariff on generic drugs beginning in August 2028, with a planned increase up to 200% in 2029, one year after his term ends. Generics are one of the few areas where Americans pay relatively low prices compared with other countries. Tariffs of this magnitude could have enormous consequences — raising costs, worsening shortages, and putting access to lifesaving medicines at risk. If the administration intends to lower prescription drug prices, it should not pursue policies that threaten to raise them. Imposing massive tariffs on generic medicines risks making lower-cost options millions of Americans rely on more expensive and harder to access. — [P4AD, Truth Social, USA Today, TIME, Reuters, Common Dreams]
Patient Advocate Spotlight: Elaine Kniepfel
Condition: Multiple Sclerosis
Drugs: Copaxone ($100,000/year) and Provigil ($8,000/month)
Background: Retired educator with 47 years of service as a teacher and administrator from Kansas
In Her Words: “Even with Medicare, the $2,000 cap is too much for retired people on fixed incomes. It’s abhorrent that drug companies charge so much to the people who need medicine most.”
WASHINGTON, D.C. — Today, the House Energy and Commerce Committee advanced two bipartisan bills supported by P4ADNow that would increase competition and help lower prescription drug costs:
The Biosimilar Red Tape Elimination Act (H.R. 5526), which would codify existing FDA guidance on interchangeability and remove requirements for separate “switching studies” to prove interchangeability — cutting unnecessary regulatory red tape that delays lower-cost biosimilars from coming to market.
The Stop GAMES Act (H.R. 8908), which would curb pharmaceutical companies’ abuse of citizen petitions by allowing the FDA to reject petitions filed solely with the purpose of delaying competition and keeping lower-cost alternatives off the market.
Both bills were added to the Lower Costs, More Transparency Act (H.R. 9393), which the committee unanimously passed during today’s markup. Last month, the Senate version of the Biosimilar Red Tape Elimination Act also advanced through the Senate HELP Committee.
In response, P4ADNow CEO Merith Basey released the following statement:
“Drug companies systematically game the patent system to delay lower-cost alternatives from coming to market, keeping prices high for patients. Today’s bipartisan vote is an important step toward increasing competition in the marketplace. We’re especially encouraged to see the Biosimilar Red Tape Elimination Act advance through committee in both chambers, bringing this bipartisan reform one step closer to becoming law.
We urge Congress to swiftly pass these reforms so patients can benefit from lower-cost competition.”
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Patients For Affordable Drugs Now is the only national, patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNow is bipartisan and does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more, visit: PatientsForAffordableDrugsNOW.org
Welcome to the Week in Review.
New FDA Move Set To Hinder Big Pharma’s DTC Advertisements
The FDA is expected to strengthen transparency and warning requirements for direct-to-consumer (DTC) prescription drug advertisements as part of the administration’s 2026 regulatory agenda – a move that could make ads increasingly difficult and costly to air – even if it falls short of an outright ban. That shift is significant given how effective DTC advertising is: even small increases in ad spending are associated with major jumps in drug sales. At the same time, lawmakers have advanced proposals like the bipartisan, P4ADNow-endorsed No Handouts for Drug Advertisements Act, which would eliminate tax breaks that subsidize this marketing. Together, these efforts signal growing momentum to rein in a practice – unique to the U.S. and New Zealand – that prioritizes industry profits by encouraging the overprescribing of expensive brand-name products, often while downplaying potential side effects. — [POLITICO, OMB, Axios, TIME, Washington Examiner, Sen. Hawley]
Judge Blocks Colorado PDAB and Enbrel Price Relief
A federal judge has temporarily blocked Colorado’s Prescription Drug Affordability Board (PDAB) from implementing a price cap on Enbrel, halting a first-in-the-nation effort to rein in the cost of high-priced prescription drugs through upper payment limits. The policy would have capped the drug at $600 per week, compared to a monthly list price of over $7,000. The ruling comes as the pharmaceutical industry continues to challenge state-level affordability efforts, with Enbrel manufacturer Amgen praising the decision. For Colorado patients who rely on Enbrel, the pause means continued exposure to high and unaffordable prescription drug costs while the case moves forward. The decision underscores the ongoing legal and political barriers facing efforts to lower drug prices – even as states attempt to take action. — [STAT News, CMS, Colorado Sun, Endpoints News]
HIV Drug Costs Set to Surge for Medicare, EPIC Would Make It Worse
The cost of HIV drugs for Medicare is projected to nearly triple over the next decade, rising from $6.4 billion in 2026 to $17.8 billion by 2035, according to a new study. The analysis finds that the high cost of antiretroviral therapy — not other health conditions — is the primary driver of spending for older Americans living with HIV. These findings reinforce concerns previously raised by P4AD: drugmakers continue to raise prices on HIV treatments while pushing policies that would delay cost-saving reforms. Tools like Medicare drug price negotiation would significantly reduce costs, but many HIV drugs could face delayed eligibility under pharma-backed proposals like the EPIC Act — which would extend the timeline before negotiation could begin. As more people with HIV age into Medicare, the stakes are clear: without protecting and strengthening Medicare negotiation, patients and taxpayers will be left to absorb the rising cost of lifesaving medications. — [JAMA, P4AD]
Bipartisan Push for Broader Insulin Price Caps
Sens. Collins (R-ME) and Shaheen (D-NH) highlighted their bipartisan INSULIN Act this week, which would expand Medicare’s $35 monthly insulin cap to private and employer insurance. While out-of-pocket caps don’t address the root cause of high list prices and instead shift costs away from patients to the government, growing GOP support signals meaningful bipartisan momentum. The proposal was recently folded into a broader drug pricing bill and could see action in an upcoming markup. — [Johns Hopkins, Sen. Shaheen, P4AD]
ICYMI: The FDA approved a new sickle cell disease gene therapy, Casgevy, for children over 2, providing a lifeline for families dealing with this debilitating disease, but it comes with an enormous price tag — Casgevy has a list price of over $2.2 million. Gene therapies are often customized and transformative, but the cost barrier in the United States severely limits patient access, particularly when the same drugs often launch at significantly lower prices in countries like Spain and Brazil.
Patient Advocate Spotlight: Doug Lusty
Condition: Crohn’s disease
Drugs: Stelara ($2,641.09 per injection every eight weeks)
Background: Retired state auditor living in Kaysville, Utah
Read more about Doug in his new Deseret News profile:
“‘Between my wife and I, we were on five of the first 10 medications to get negotiated for Medicare,’ he said. He added that the negotiated prices can still be expensive, but not as expensive as before.”
“Doug retired after 32 years with the state government due to health and meeting his medical needs — not just prescriptions — on a fixed income is challenging.”
“Both of them have at times in recent years skipped medication doses because of the cost. And they’re not alone.”
“Doug Lusty said the bright spot has been that some of the medication costs for them have gone down, thanks in large part to the ability Medicare now has to negotiate the prices on some of the more expensive drugs the program covers.”
