President Donald Trump has now reached most-favored-nation drug-pricing agreements with 26 pharmaceutical manufacturers, after adding nine mid-sized companies this week in deals that carry a built-in reward: exemption from the administration’s steep new tariff on imported patented medicines. The newest entrants — Alcon, Astellas Pharma, BeOne Medicines, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva Pharmaceuticals and UCB — push the roster to companies covering 89% of the U.S. branded drug market. The trade at the center of each deal is explicit: manufacturers that commit to charging Americans the lowest price paid anywhere in the developed world get relief from Section 232 duties that hit everyone else.
The Most-Favored-Nation Framework Behind the Nine New Deals
The nine manufacturers joining this round are notably more geographically diverse than the first wave of major pharmaceutical companies that signed on between last September and this past April. Sun Pharma is based in India, Teva Pharmaceuticals in Israel, Astellas Pharma and Kyowa Kirin in Japan, and CSL in Australia, marking the first time non-Western drugmakers have joined Trump’s most-favored-nation campaign. Together, the nine agreements target medications for hemophilia, Parkinson’s disease, macular degeneration, glaucoma, liver disease, skin conditions and multiple forms of cancer, according to the deal terms.
Under the agreements, every state Medicaid program gains access to the same most-favored-nation prices the nine companies negotiate for their newest and priciest drugs, extending a mechanism the Centers for Medicare & Medicaid Services runs through its GENEROUS model, which negotiates Medicaid drug prices directly with manufacturers. Two of the smaller signees show how narrow some of these deals are: BeOne Medicines’ only Medicaid-relevant product is the cancer drug Tevimbra, while BridgeBio’s sole commercial brand, Attruby, treats a rare heart condition called transthyretin amyloid cardiomyopathy.
The fact sheet, however, offers few specifics on which individual products qualify for the new Medicaid pricing or what discount level the nine companies agreed to provide, a gap consistent with the first round of deals, whose full terms have also remained largely undisclosed eight months after Regeneron became the 17th company to sign.
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The Section 232 Tariff Trade That Makes the Deals Work
The financial logic binding these agreements together is a tariff the White House imposed on imported patented pharmaceuticals under Section 232 of the Trade Expansion Act of 1962, a duty that reaches 100% for drugmakers that never signed a most-favored-nation pricing deal. Companies that did sign, including the nine added this week, qualify instead for a 0% tariff rate on the same products, under an exemption window that trade attorneys tracking the program have described as running from late September 2026 into January 2029. Generic drugs and biosimilars remain excluded from the tariff regardless of MFN participation.
The administration’s own release did not mention tariffs, but individual companies made the connection explicit within hours of Monday’s news that nine additional drugmakers had joined the pricing framework. Belgium-based UCB and California-based BeOne Medicines both said their new agreements secure exemptions from the Section 232 duty, tying their U.S. manufacturing investment pledges directly to relief from the tariff. The pattern mirrors the first round of deals, when Pfizer, AstraZeneca, Novartis and more than a dozen other major drugmakers won temporary tariff immunity in exchange for the same pricing concessions.
The tariff-for-pricing trade has defined the campaign since Trump signed an executive order in May 2025 directing the effort, then sent letters that July to 17 major manufacturers demanding most-favored-nation pricing. Pfizer became the first to sign that September, followed through the fall and winter by AstraZeneca, Eli Lilly, Novo Nordisk, Amgen, Johnson & Johnson and a dozen more, with Regeneron completing the first wave in April 2026 before this week’s nine mid-sized companies opened a second one.
Supply Chain Pledges and the Administration’s Savings Claims
Beyond pricing, the nine companies committed to invest at least $19.6 billion collectively in U.S. manufacturing in the near term, and several agreed to donate active pharmaceutical ingredients to the Strategic Active Pharmaceutical Ingredients Reserve, a stockpile meant to reduce dependence on China and other foreign API sources. UCB pledged 163 tons of the anti-seizure drug levetiracetam; Sun Pharma committed 71.4 tons of the antibiotic clindamycin and 6.75 tons of doxycycline; Teva Pharmaceuticals offered 45 metric tons of metronidazole and 4.8 tons of amlodipine; and Astellas Pharma added 25 kilograms of the transplant drug tacrolimus.
CSL tied its agreement to a previously disclosed $1.5 billion expansion of a plasma-manufacturing plant near Chicago, while BridgeBio said it does not expect to face future Medicaid pricing mandates on Attruby as a result of signing. The administration credits its broader push, now spanning two rounds of deals dating back to that Pfizer agreement, with more than $700 million in patient savings since the TrumpRx discount portal launched in February, plus $216 million saved by more than 500,000 seniors who gained access to $50-a-month GLP-1 obesity drugs since July.
Not every mid-sized company is on board. Ten biotechs, including Alkermes, Alnylam, Ardelyx, BioMarin, Exelixis, Incyte and Neurocrine Biosciences, formed the Midsized Biotech Alliance of America in February to lobby against the campaign, arguing that companies dependent on a single marketed product are far less equipped than cash-rich Big Pharma to absorb the pricing concessions the administration is demanding.
The Council of Economic Advisers, the White House’s own in-house economics shop, projects the full slate of MFN deals will save Americans $600 billion over the next decade, a projection that has not been verified by an outside body and that depends on drugmakers actually holding to voluntary pricing commitments rather than a binding law. With mid-sized biotechs still organized against the program and generic and biosimilar makers sitting entirely outside the tariff structure, the next test is whether the remaining 11% of the branded drug market follows the nine companies that signed this week, or holds out against both the pricing terms and the tariff they were built to avoid.
This article was produced with the assistance of AI and reviewed by The Money Overview editorial team before publication.
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