US drug pricing policy changes introduced in 2025—including Most-Favored Nation agreements and CMS drug price models referencing international prices—could have repercussions for pricing and access in global markets in 2026 and beyond. Current directional understanding of this policy includes: potential use of net prices, which are usually confidential; the approach to selection of comparator markets; and the intertwinement of US drug pricing policy with broader US trade agreements.

However, there are several open questions, the answers to which have  implications for the future of global market access:

• Implementation: Will US prices respond quickly to delayed availability of additional market reference prices? Will other countries challenge the removal of net price confidentiality, even if manufacturers voluntarily share net prices with the US government? Will there be further changes to international trade agreements that impact markets? What could further change in impacted US market segments (and hence asset profiles) mean for global pricing strategies?
• Impact: How will other countries respond with respect to drug pricing, reimbursement and wider pharmaceutical policy, in the context of ongoing tension between health budgets and trade policy demands?

The impacts of US reference pricing on the global pharmaceutical market are not entirely clear yet, and manufacturers should be cautious in making major strategic decisions based on this speculation. However, there are six short- and long-term implications of this policy that manufacturers can carry into the new year:

1. Mitigation of US price impact through adjusted market launch timing. Manufacturers may need to go beyond usual launch market and indication sequencing strategies to support US market price. Such strategies must be built on a clear understanding of anticipated market net prices, the risk of visibility to the US, and the impact of an individual market price on both US models and other markets through international reference pricing.
2. Need for approaches to maximize influencing ex-US prices. There are several approaches to maximize price in markets where this is determined by volume/expenditure coupled with demonstration of value over standard-of-care. Return on investment in evidence and articulation of value may be revised upwards, alongside increased benefit of policy-shaping activities that advocate recognition of broader societal value, beyond healthcare system value and traditional clinical outcome measures. Achievable price may be maximized through choice of reimbursement indication (trading price against volumes). Increased strategic use of innovative pricing approaches may also be anticipated, whereby reduction in payer uncertainty can be reflected in a higher, as well as more opaque, price.
3. Increased importance of optimal access in wider global markets. Manufacturer need for global revenue stability in this time of change suggests growing importance of achieving optimal access across an expanded set of markets. This may require a diversified channel strategy, e.g., via direct-to-consumer in the US, private insurance in the Middle East and Latin America, and through alternative funding models in Asia-Pacific. In the longer-term, policy-shaping activity will be critical to unlock value recognition of pharmaceuticals across markets, together with evidence generation that is relevant to the different channels.
4. New traction for policy-shaping activities that nudge for change in payer approach. The emerging environment could further mean renewed leverage for activities that support change in pricing and reimbursement methodologies across both established and emerging markets. This would be in light of pressure from trade negotiations with the US, but more broadly, also that medicine supply and associated industrial investment are increasingly viewed as critical national infrastructure. However, manufacturer policy functions may also need to respond to political backlash, if strategic decisions on launch markets and price have negative consequences for patient access.
5. Need to react to a changing global competitor landscape. In the longer-term, pricing pressure and delayed launches could lead health systems to seek alternative global sources of innovative therapies. This would accentuate key existing trends, for example, the consequences of current drug discovery growth in China. Market access strategy development will need to understand and react to this changing landscape.
6. Evolution of organization and remit of global market access. In the short term, internal governance change may be needed to work through now truly global pricing strategies, reflecting that a low price in a small market could now erode US revenues. Longer-term, decision-making from early pipeline onwards will need greater integrated thinking from US and global teams such that asset prospects can be fully understood.

As 2026 progresses, monitoring and scenario evaluation may need to progress further to decisions by manufacturers to minimize negative short-term impact, according to their individual portfolio risk. This must be grounded in deep US policy understanding to tease out the implications for products and portfolios in an evolving situation.

Dive Deeper

The implications identified above highlight the possibility for long-term change and are informed by a global picture of market access policy, challenges and opportunities. Avalere Health is well-placed to offer such short- and long-term support, bringing together expertise from our US, global and Asia-Pacific based teams.

Connect with us to learn more about how Avalere Health’s pricing, market access, and policy subject matter experts can support you.