Congress Seeks Answers on Most-Favored-Nation Drug Pricing Agreements and Their Impact on Medicaid

The first week of March 2026 brought coordinated congressional oversight targeting the Trump administration's most-favored-nation (MFN) drug pricing initiative. Congressional leaders sent several letters to President Trump and pharmaceutical manufacturers requesting details about the MFN agreements such manufacturers struck with the administration, demonstrating the budding congressional scrutiny of the MFN pricing initiatives, where the impact on patients and state budgets still remains uncertain.

The MFN Deal Landscape

As we previously reported, after the Trump administration issued a number of executive orders and letters threatening tariffs and other actions against pharmaceutical manufacturers whom did not comply with President Trump’s MFN pricing requirements, manufacturers began striking MFN agreements with the Trump administration. To date, President Trump has secured MFN pricing agreements with 16 of the 17 manufacturers initially identified by the administration. 

According to press releases issued by the manufacturers, in exchange for a three-year exemption from potential Section 232 tariffs and future drug pricing mandates, manufacturers agreed to: 

• Offer MFN pricing to state Medicaid programs; 

• Participate in TrumpRx.gov, the recently launched federal direct‑to‑consumer platform; and 

• Invest in U.S. manufacturing infrastructure and/or research and development. 

Although each MFN agreement was publicly announced, the exact details of these agreements remain largely confidential. Neither the administration nor the participating manufacturers have shared the agreements with Congress. Moreover, many of the MFN agreements contain confidentiality provisions that prohibit the manufacturers from publicly disclosing the agreements’ terms. As a result, the scope and practical impact of the MFN pricing deals cannot be independently evaluated. 

The March 5, 2026 Letter to President Trump

On March 5, 2026 the ranking members of four House of Representatives and Senate committees wrote a joint letter to President Trump demanding unredacted copies of the MFN agreements. Prompted by President Trump's State of the Union address, in which he called on Congress to "codify [his] most favored nation program into law," the signatories reason that Congress cannot take such action without first meaningfully evaluating complete and unredacted copies of each MFN agreement to ensure the terms are in the best interest of Americans.

In a companion letter sent the same day, three Democratic Congressional leaders wrote to Secretary of the United States Department of Health and Human Services (HHS), Robert F. Kennedy, Jr., requesting details on the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) and Global Benchmark for Efficient Drug Pricing (GLOBE) models, two Centers for Medicare & Medicaid Services (CMS) demonstrations intended to lower Medicare drug prices through international reference pricing. According to the letter, pharmaceutical companies with MFN agreements have publicly stated that they are exempt from GLOBE and GUARD, thus causing confusion as to which drugs ultimately will be subject to GUARD and GLOBE. The letter requests that HHS clarify which drugs will qualify for participation in the GLOBE and GUARD models and further requests future access to certain agreements between CMS and manufacturers that waive GLOBE and GUARD model participation.

The March 6, 2026 Letters to Pharma

One day later, Senator Ron Wyden, the Ranking Member of the Senate Finance Committee, and six fellow Democratic senators sent letters to 11 pharmaceutical manufacturers requesting details of their MFN agreements and evidence that their deals will deliver savings to the Medicaid program. 

According to these letters, the senators expect MFN Medicaid pricing commitments to flow through the Generating Cost Reductions for U.S. Medicaid (GENEROUS) Model, a voluntary demonstration program launched by CMS in January 2026. Under the GENEROUS model, CMS negotiates supplemental rebates and coverage terms with participating manufacturers to bring Medicaid drug costs closer to international pricing levels. But, as the senators point out in their letters, state Medicaid programs already receive statutory discounts under the Medicaid Drug Rebate Program. The incremental value of an MFN commitment depends on whether the MFN price is lower than the net price that states already pay. 

The letters ask each manufacturer to specify, among other things: 

• Which drugs would be covered by the Medicaid part of the MFN agreement;

• The MFN price for each drug; and 

• Whether those MFN prices undercut existing Medicaid net pricing.

The urgency behind these requests is tied to the One Big Beautiful Bill Act (OBBBA) that was enacted in July 2025, which included nearly $900 billion in cuts to the Medicaid program. This information could potentially help state Medicaid programs, which are now navigating substantially reduced federal funding because of the OBBBA cuts, and need reliable pricing data to make sound budgetary decisions and program planning. 

The senators set a March 23, 2026, deadline for responses, citing the immediacy of state budget cycles and special legislative sessions.

Looking Ahead

The weeks ahead will likely bring heightened attention to the substance of the MFN agreements. Much will depend on whether manufacturers meet Senator Wyden's March 23, 2026 deadline and whether the White House provides Congress with the requested information on the confidential agreements. It appears that these disclosures will be central in determining whether the MFN agreements receive the congressional support necessary to codify them into law.

Subscribe To Viewpoints