Most Favored Nation: Global Benchmarking to Reimagine US Drug Distribution

While experts and professionals often point the finger at pharmacy benefit managers (PBMs) for rising US drug costs, medication access is hindered by a complex drug supply chain that relies on several various stakeholders within and outside of the pharmacy industry. Despite many of these issues being deliberated upon for years now, challenges in drug cost and access have reached a boiling point in the US, forcing the current Presidential Administration to try its hand in enforcing change.

On May 12, 2025, the Trump Administration reintroduced the Most Favored Nation (MFN) policy in an executive order titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients.”¹

“The idea was shelved, [but] now it's back because we're into Trump 2,” Ron Lanton III, Esq, partner at Lanton Law PLLC, told Drug Topics. “I think what's happening now is, [Trump’s] going out and writing letters to pharma, or he'll go to the news and he'll say, ‘Hey, look, prices are too high,’ and we have this MFN policy.”

From the complex supply chain to the various levers President Trump has pulled in the prescription drug space since he was re-elected, Lanton believes the administration’s most recent approach toward MFN is seemingly trying all available options and avenues.

“It's more like a kitchen sink approach, where he's been using [Section] 232 security investigations,” continued Lanton. “He's been doing sector/country tariffs to see if we can drive the price down. He's been doing trade retaliation against countries that really aren't moving fast enough.”

With MFN introduced and shelved during his first term, it is back and has looked different during what Lanton referred to as “Trump 2.” This time around, the government’s approach at lowering drug costs involves brand-new ways of manipulating the value and distribution of drugs as well as the manufacturers that market them.

Listen to this week’s episode of Over the Counter as Lanton provides some much-needed nuance to a developing policy expected to enact significant change in the pharmacy industry and beyond.

Stay tuned for weekly podcast episodes of Over the Counter powered by Drug Topics. Check out our most recent episode with Megan Smith, PharmD, who discussed pneumococcal vaccines and the pharmacist’s role in managing them.

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REFERENCE

Rogers HA. Most-favored-nation prescription drug pricing executive order: legal issues. Library of Congress. June 5, 2025. Accessed December 17, 2025. https://www.congress.gov/crs-product/LSB11319