Health Economics for Builders and Backers, June 2026

What’s New and What Matters this Month

This is our monthly briefing on some of the new developments in health economics that may be relevant for biopharmaceutical companies and investors. We highlight what’s new this month and break down what matters for company builders and backers.

Have European countries changed their drug pricing and reimbursement policies in light of increased U.S. pressure on global pharmaceutical pricing?

The U.S.-U.K. pharmaceutical pricing agreement remains the most formalized response, but there is still a lot of chatter elsewhere. European governments appear to be in what global market access consultant Neil Grubert describes as a “monitoring phase”. Some governments seem to be assessing the implications of U.S. Most Favored Nation (MFN) policies and discussing potential proposals, but few concrete changes have been implemented to date. Neil notes a few potentially related actions like Sweden reviewing its willingness to pay for pharmaceuticals, Spain’s Health Committee of the Congress of Deputies advancing a provision toward net price confidentiality, and Switzerland considering a proposal for a dedicated fund for newly launched drugs, but these are not yet formalized or implemented.

For builders and backers: For now, most of these initiatives remain at the discussion or proposal stage. Although the policy conversation appears to be shifting, it remains unclear if and how European governments will adjust their pricing and reimbursement policies to balance incentives for innovation with continued pressure to contain costs.

Can trade policy be used to encourage other countries to pay more for innovative medicines?

This month, the U.S. Trade Representative (USTR) initiated a Section 301 investigation into Germany “to determine whether persistent underpayment for innovative pharmaceutical products by Germany is unreasonable or discriminatory and burdens or restricts U.S. commerce”. Ron Lanton, a transatlantic regulatory strategist, wrote: “The investigation appears tied to German healthcare cost-containment legislation that could further reduce spending on innovative medicines.” Lanton also explains: “This does not mean tariffs are inevitable. USTR has suggested that the issue could potentially be resolved through negotiations, including a path that expands access to innovative medicines while ensuring fair reimbursement for pharmaceuticals made by American workers.”

For builders and backers: The Trump Administration is committed to finding ways so that American patients are not “shouldering a disproportionate share of global pharmaceutical research and development”. This is going beyond domestic drug pricing policies to include trade policy. While critics of MFN have noted that other countries have little incentive to pay more for innovative medicines, Section 301 investigations could provide additional leverage.  

Did the Medicare Part D out-of-pocket spending cap increase the use of prescription drugs?

The Inflation Reduction Act redesigned Medicare Part D to reduce patient out-of-pocket spending. Beginning in 2024, patient out-of-pocket spending was effectively capped at $3,300 per year. Then in 2025, the annual out-of-pocket spending cap of $2,000 took effect. Cai and colleagues examined how these changes impacted prescription drug utilization and found that these out-of-pocket caps were associated with increased prescription fills, particularly for very high-cost medications (i.e., priced more than $7,000 per month).

For builders and backers: Insurance benefit design influences utilization, particularly for specialty medicines with high patient cost sharing. As pharmacy benefits continue to be redesigned, changes in patient out-of-pocket spending may have meaningful implications for real-world uptake as well as utilization and revenue projections for high-cost therapies.

Have companies already changed their launch strategies following the May 2025 MFN Executive Order?

A recent analysis by Ramagopalan and Ryan examined changes in new product launches following the May 2025 executive order on MFN pricing. Among the European countries in the MFN reference baskets for GUARD and GLOBE (two different Center for Medicare and Medicaid Innovation pilot programs to test MFN pricing), the authors report that new product launches fell by nearly 30% in the year after the executive order as compared with the preceding year. By comparison, new product launches in the United States declined by about 10% in the year after the executive order as compared with the preceding year. While the analysis cannot establish that the Executive Order caused these changes and there are a number of important limitations, it suggests that launch strategies may already be evolving in anticipation of future pricing policies.

For builders and backers: If MFN policies continue to move forward, decisions about where and when to launch products become increasingly intertwined with global pricing strategy as innovators seek to preserve pricing flexibility while maintaining broad patient access.

How do US payers value treatments that reduce major adverse cardiovascular events for people with cardiovascular disease?

We released a report this month that examined how the US insurance market has historically valued (i.e., reimbursed) advanced lipid-lowering therapeutics for the secondary prevention of cardiovascular disease. Rather than focusing on the list or net prices of approved therapeutics, we anchored their net prices on how effective they were at reducing cardiovascular events. This allows us to create a pricing framework that differentiates based on clinical efficacy. Based on these historical market rewards, a value-anchored price for a novel therapeutic for the secondary prevention of cardiovascular disease that reduces cardiovascular events by 20-30% could range from $4,300 to $9,000 per year. Table 3 in our report provides value-anchored price estimates for different levels of clinical efficacy.

For builders and backers: These estimates may be relevant as a reference point to assess the pricing acceptance and competitive positioning for potential new entrants to the secondary prevention treatment landscape.

What is the range of economically justified launch prices for a novel therapeutic for chronic obstructive pulmonary disease?
We released another report this month that created a health economic framework to estimate value-informed launch prices for novel therapeutics for chronic obstructive pulmonary disease (COPD). Our analysis presented a range of value-informed prices depending on treatment effectiveness and analytic framework. Several evidence parameters meaningfully influence the value-anchored price estimates, including the relative rate reduction in the annualized exacerbation rate, the effect an exacerbation has on quality-of-life, and the exacerbation effect on FEV₁ decline. Economic analyses that account for broader societal impacts and lifecycle pricing support higher value-anchored price estimates.

For builders and backers: Treatments that reduce COPD exacerbations generate meaningful economic value, supporting the consideration of value-informed price estimates in pricing discussions. Understanding how clinical outcomes translate into value-based price estimates can help contextualize the potential economic value of pipeline therapies, guide evidence generation, and inform pricing acceptance in an environment of increasing pricing scrutiny.

How do US payers value treatments that reduce exacerbations for people living with chronic obstructive pulmonary disease?

We released a report this month that examined how the US insurance market is valuing (i.e., reimbursing) novel treatments for chronic obstructive pulmonary disease (COPD). Current reimbursement patterns suggest an implied market reward per person treated of approximately $5,000-$7,000 per year for every 10% reduction in COPD exacerbations. If a development-stage therapy demonstrated a 30%-40% reduction in exacerbations, historical market rewards would suggest a net price range of around $16,000 to $29,000 per year. The table in our report provides value-anchored price estimates for different levels of clinical efficacy. The implied reimbursement value for reductions in exacerbations may be higher for COPD therapeutics with a narrower indication (e.g., inadequately controlled COPD and an eosinophilic phenotype).

For builders and backers: These estimates may be relevant as a reference point to assess the pricing acceptance and competitive positioning for potential new entrants to the COPD treatment landscape.