Commercialization

A new round of pricing deals between the White House and pharmaceutical companies will have negligible effects on sales and profits for the industry while offering relief from government threats, Wall Street analysts said.

In December, President Trump announced agreements with nine more drugmakers that he said would significantly lower the prices of prescription medicines. 

The companies each made separate deals to offer discounts on specific drugs, many of which were already heavily rebated or nearing the end of their exclusivity. In return, the companies will receive three years of relief from Trump’s tariffs.

The deals amount to “another round of pandering on carefully selected drugs,” William Blair analyst Matt Phipps wrote in a note to clients. While the medicines will be offered at discounts for those who pay cash, there’s unlikely to be a significant difference in net prices, he said. The cash prices will likely be well above typical co-pays, meaning people with insurance will buy drugs the same way as in the past.

Indeed, one of the companies involved in the latest round of negotiations, Gilead Sciences, said it expects “the financial impact to be manageable in 2026 and beyond.” That’s likely true of all nine deals, Phipps said, telling clients he does not expect “significant impacts on the companies’ growth prospects.”

For their part, investors continue to push pharmaceutical and biotech stocks higher. Pharma and biotech indexes rose for much of 2025, since dipping last April as Trump threatened the industry with “major” tariffs. The threats led to a flurry of announcements of planned investments in U.S. manufacturing, but in the end the tariffs came with exemptions that significantly blunted their impact.

The latest deals are part of Trump’s push to bring “most-favored-nation,” or MFN pricing to pharmaceuticals. The idea is to align costs for U.S. consumers with those in countries that have price controls. In July, Trump sent letters to 17 large drugmakers giving them 60 days to lower prices or face government action.

Pfizer, AstraZeneca, Eli Lilly, Novo Nordisk and EMD Serono previously struck deals with the White House before December’s batch of agreements with Gilead, Merck & Co., Amgen, Bristol Myers Squibb, GSK, Novartis, Sanofi, Genentech, and Boehringer Ingelheim. Johnson & Johnson and AbbVie followed in early 2026.

In addition to specific drug pricing deals, the White House claimed the agreement will “ensure foreign nations can no longer use price controls to free ride on American innovation by guaranteeing MFN prices on all new innovative medicines the nine companies bring to market.”

It’s unclear how that provision will be enforced. And at least one company, Bristol Myers, said its deal means it “will not be subject to future pricing mandates.” The agreements also appear to have offered additional special enticements, with the Food and Drug Administration announcing national priority vouchers for speedy reviews for two Merck experimental drugs on the same day.

The lack of transparency on the negotiations has led Democrats to cry foul. Four top lawmakers sent letters to AstraZeneca, Lilly, Novo and Pfizer seeking information. “Skepticism and scrutiny are warranted as the Trump Administration has repeatedly made announcements that fail to meet their stated goals and instead only increase costs on the consumer,” they said.

The pharmaceutical tariffs President Donald Trump announced in September could have a limited impact on the pharmaceutical industry due to multiple exemptions for generics, exports from Europe and companies already onshoring manufacturing.

The tariffs, unveiled via a post on the social media platform Truth Social, weren’t accompanied by legal documents, leaving key details unclear. However, the 100% levies, which are much smaller than the figure previously floated by the Trump administration, alleviate some uncertainty around U.S. drug pricing policy.

The flurry of drugmaker investments in U.S. drug production in 2025 should exempt a wide swathe of the industry’s drugs from the new levies. The tariffs won’t apply, Trump posted, to companies that are “building their pharmaceutical plant in America,” with “building” defined as “breaking ground” or “under construction.”

Focusing on branded drugs will also prevent price escalation for inexpensive generics, while lowering the risk of new shortages or worsening existing ones.

Meanwhile, tariffs on branded drugs exported from the European Union, which constitute a large share of the medicines made overseas, should be capped at 15% because of a trade agreement reached in August. EU officials reiterated the terms of that deal later on, even as a European pharmaceutical lobbying group criticized the new charges coming from the Trump administration.

In research notes, Wall Street analysts largely saw the news as a positive outcome for the sector, since the 100% levies are significantly less than the 200% or more Trump originally threatened and many companies appear to be exempt. 

“Many large-cap biopharmaceutical companies should not be exposed because they are engaged in some sort of U.S. facility construction activity, but it is difficult to predict which smaller U.S. biopharma companies may face exposure,” Leerink Partners analyst David Risinger wrote in a note to clients.

Several drugmakers also subsequently cut deals with the administration to gain tariff reprieves in exchange for lowering the prices of some drugs in the U.S. Those agreements, though, also don’t appear likely to significantly damage earnings prospects.

Sponsored content

By Evaluate

Biopharma is back, but not everyone is benefitting. Qualified optimism is the mood music as the sector heads into 2026.

After several years of a tough financing climate and sparse investor support, particularly on the public markets, a cautious recovery makes sense. When it comes to backing R&D, the stock market needs unequivocal evidence to get excited. For the first time in a while, excitement is translating into big valuations.

There is no halo effect warming those yet to deliver, however. Perhaps that will come, if the sector keeps hitting endpoints. The biotech sector does not need or want another boom – it needs more risk-taking from investors.

Pharma also needs to keep spending – October and November 2025 saw $36bn deployed on biotech buyouts, with the approaching patent cliff forcing management teams into action. A strong takeout theme always helps tempt money into a sector and more M&A is expected for 2026.

Commentators say the biotech sector that is emerging from the long drought is smarter, leaner and higher quality, run by investors and executives who know how to spend money wisely. For the rally to continue, that needs to be proved correct in 2026.

2026 Top Sellers

What can we expect from this reshaped pharma market in 2026? The incretin space will remain the big theme in 2026, with all eyes on the fierce battle between market leaders Novo Nordisk and Eli Lilly. The US pharma giant is set to take the lead in the metabolic space in 2026 with tirzepatide – some analysts reckon the drug has $100bn potential. Lilly’s highly valued suite of follow-on projects has investors betting on market dominance for years to come.

Top Selling Drugs in 2026

Lilly became pharma’s first $1tn market cap company in 2025, a fortune that contrasts starkly with Novo Nordisk’s stock market decline. The FDA approved “Wegovy in a pill” for obesity in December. Stronger than expected demand would provide a fillip for Novo Nordisk and initial sales in 2026 will be a big focus.

Meanwhile, Merck & Co will be heartened to see Keytruda retaining its position as the top-selling drug brand in 2026, although this is only achieved when adding in sales of a new subcutaneously administered formulation of the cancer blockbuster. Called Keytruda Qlex, the product offers convenience over the original intravenous drug and provides valuable franchise extension as this class of checkpoint inhibitor nears the end of its patent-protected life.

Waiting in the Wings

If the top sellers of 2026 are well-established names, what are the drugs set to hit the market in 2026 and what will their impact be? This question takes us straight back to the GLP-1 arena with Evalute’s data forecasting that the top two potential launches by 2032 sales are set to be Novo Nordisk’s Cagrisema and Eli Lilly’s Orforglipron – both targeting obesity and type 2 diabetes.

Beyond obesity, Gilead and Arcellx’s anito-cel is causing a stir in the blood cancer space, generating highly competitive data to Legend/J&J’s blockbuster Carvykti. In solid tumors, hormone-driven breast cancer could see new options in 2026, with projects from Celcuity and AstraZeneca going before regulators.

Immunology and inflammation will continue to run hot in 2026. Several novel projects in this therapy area are approaching the market or late-stage data readouts in 2026. Roivant is a big player here, with a wide pipeline across various ‘vant subsidiaries and the company could see its first blockbuster approval in 2026 with brepocitinib.

There is more detailed analysis in the full 2026 Preview report by Evaluate which is available here.

Novo Nordisk and Eli Lilly will sell their GLP-1 drugs for obesity and diabetes to some Medicare enrollees for $245 a month under an agreement hammered out with the Trump administration, the White House announced.

Through the deal, the two companies will also offer some of the same drugs through an online government portal for about $350 a month. Lilly and Novo were additionally required to sell starter doses of their coming oral obesity medicines for $149 a month. They’ll have to offer all their weight loss drugs to state Medicaid programs at “most favored nation” prices, too. Novo’s pill was approved in December and launched weeks later.

The figures represent discounts to the list prices of Wegovy and Zepbound, which are $1,350 and $1,080 a month, respectively, as well as the $499 monthly charge on Lilly and Novo’s direct-to-consumer sites. But comparisons are different when weighed against the “net” prices that follow negotiations with insurers.

The outgoing Biden administration in its waning days sought to extend Medicare and Medicaid coverage to Wegovy and Zepbound, but the Trump administration shelved that effort.

The deal announced with the Trump White House is more expansive, involving both a method of broadening access to obesity drugs and the administration’s push to equalize U.S. prices with those paid in other developed nations. The agreement even dipped into other parts of Lilly and Novo’s portfolio, with both agreeing to discounted prices for migraine and diabetes medicines that are sold through the new government website.

After speaking with Lilly executives, Leerink Partners analyst David Risinger wrote that the company believes the deal will make 40 million more Americans eligible for treatment with its obesity drugs. His team also estimates that the future $245 monthly price for Zepbound is about 55% of current Medicaid and Medicare net prices.

Still, the Medicare price for GLP-1 drugs will be offered through a pilot program that will cover most beneficiaries, Novo said. That may be necessary, as the law that authorized Medicare coverage of prescription drugs specifically bars weight loss products. But it also likely limits which Medicare beneficiaries will qualify, and could have a fixed expiration date. Those that do benefit will have a $50 monthly copay.

The agreement also won’t apply to the vast majority of people who receive their medications through commercial insurance. Risigner’s team estimates that the average U.S. commercial plan pays about $450 to $500 per month for Zepbound and that Lilly said it “does not have any obligations” to cut those prices. The company does expect them to “come down over time, but also expects significant volume upside,” Risinger wrote.

In agreeing to price cuts, Novo and Lilly have been spared from any tariffs on their drugs for three years, a benefit similarly handed to Pfizer and AstraZeneca following deals with the White House. In addition, the Food and Drug Administration awarded Wegovy and Lilly’s experimental obesity pill orforglipron “national priority” vouchers that could drastically shorten regulatory reviews.

Novo expects a negative “low single-digit impact” on global sales growth in 2026, when implementation of the new prices is expected. Lilly didn’t specify how its sales might be impacted.

Novo Nordisk is now offering its popular obesity drugs on Hims & Hers’ telehealth platform, ending a messy dispute that resulted in a lawsuit and a crackdown by U.S. drug regulators. 

Under a deal announced in March, Hims said it would provide access to Novo’s GLP-1 medicines — the diabetes drug Ozempic and the injectable and pill forms of the weight loss therapy Wegovy — to U.S. consumers at the same prices as other telehealth firms. Hims also agreed to no longer promote “compounded” versions of GLP-1 drugs on its website or in advertisements, and give existing patients the chance to switch to FDA-approved alternatives.

Novo, as a result, dismissed its patent infringement lawsuit against Hims while “reserving the right to refile in the future.” 

“This agreement with Hims & Hers is a meaningful win for patients in the United States,” said Novo CEO Mike Doustdar in a statement. “By expanding access through leading telehealth providers and digital care platforms, we are helping to connect more people with our FDA-approved medicines, which have been evaluated for safety and efficacy.”

The agreement represented an about-face for Hims, which had, been taking an adversarial stance against the makers of branded weight loss medicines. 

Hims is one of many telehealth firms that have used legal loopholes to capitalize on the demand for GLP-1 weight loss drugs. These firms started making lower-cost, compounded versions of Novo’s injectable Wegovy and Eli Lilly’s rival Zepbound when those medicines were in short supply. But despite lawsuits and warnings from the FDA, those efforts have continued even after the end of those shortages, as compounders have used methods of personalizing treatment regimens to try to comply with federal laws. 

Hims stepped up those plans in February, when it revealed plans to launch a compounded version of the pill form of Wegovy. The FDA approved Novo’s drug in December, making it the first pill of its kind available for obesity. And since then, early prescription totals suggest it’s gotten off to a very fast start. That progress is important for Novo, which has seen its market share eroded by compounders, pricing pressure and competition from Lilly. 

Hims attempted to quickly undercut Novo by selling a knockoff at a lower price. In doing so, Hims claimed that its copycat of oral semaglutide — the active ingredient in Wegovy — was formulated differently and involves a different delivery method to protect it during digestion. Some Wall Street analysts expressed skepticism about those claims, as Novo uses a specialized technology to ensure the effectiveness of its pill, which is a complex “peptide” drug instead of a standard small molecule. 

The move immediately spurred backlash from federal regulators and a lawsuit from Novo, prompting Hims to abandon the effort within days. It’s since completely changed course, calling the Novo deal “part of a new strategy” that’s based on providing U.S. customers with access to a “broad assortment” of FDA-approved counterparts. Compounded versions would only be offered if a clinician determines it’s “clinically necessary,” Hims said. 

Hims, for its part, said the decision is a result of industry progress in making branded GLP-1 medicines “available at more affordable prices,” which has upped demand. 

“We see tremendous growth opportunities in the U.S. with the expanding assortment of branded GLP-1 medications,” said co-founder and CEO Andrew Dudum in the company's statement.

Eli Lilly in March expanded plans to improve access to its obesity shot Zepbound through an “employer connect” channel enabling people receiving workplace-provided health coverage to directly purchase the medication without going through their standard insurers.

More than 15 independent program administrators will initially run the program, which seeks to address the inconsistent coverage decisions private health insurers issue for Zepbound and other obesity medicines. Insurer pushback has become a significant access barrier for many people who might otherwise qualify for treatment.

“For far too many people living with obesity, starting or staying on treatment isn’t just a medical decision, it’s an access decision driven by coverage and cost,” said Ilya Yuffa, a Lilly executive vice president and head of its global customer capabilities, in a statement.

The program escalates efforts by Lilly and Novo to capture a bigger share of a lucrative market that’s still believed to be somewhat unaddressed. Since the resolution of drug shortages a couple years ago, both companies have launched online “cash-pay” services that allow people without insurance coverage or with prohibitively high cost-sharing requirements to buy their weight loss medicines more cheaply. 

These services have climbed in popularity amid pressure from the Trump administration to equalize U.S. prices with what’s paid in certain other developed countries. But they’ve also been looked to by Lilly, Novo and others with would-be weight loss medicines as an emerging area of future sales growth. 

“I think it’s going to be a big part of our future,” Lilly CEO David Ricks said at a conference in January.  

The new channel represents another unorthodox attempt at spurring more drug sales. With employer connect, Lilly is selling Zepound through a set of programs that will offer anywhere from low-cost benefits administration to comprehensive plans that offer wraparound obesity care services.

The goal in doing so is to enable employers to design individually tailored treatment plans, giving Lilly a new way for Lilly to compete with the telehealth providers selling compounded versions of Wegovy and Zepbound. Drug compounders used these kinds of approaches to win patients during GLP-1 drug shortages and grab share from Lilly and Novo.

Lilly set a price of $449 a month for all Zepbound doses, similar to the cost involved in some cash-pay channels, although patients’ actual out-of-pocket costs depend on employers’ benefit designs.

The Trump administration in February unveiled a new online portal that, at the outset, allowed people to purchase around 40 drugs from a handful of manufacturers that have struck pricing deals with the White House.

Dubbed TrumpRx, the platform offers many medications already available through drugmakers’ own direct-to-consumer channels, such as Eli Lilly and Novo Nordisk’s obesity treatments Zepbound and Wegovy. Drugs from Pfizer, Merck & Co. and AstraZeneca, as well as an IVF treatment from EMD Serono, are also offered through the website. 

The products involved have all been featured in “most favored nation” pricing agreements meant to equalize U.S. drug costs with the lowest rate charged overseas. While the service could offer some financial relief to people who pay cash for drugs, it will have little effect on the vast majority of people whose medications are covered by health insurance.

Direct-to-consumer drug sales, which bypass traditional methods of paying for pharmaceuticals, represent a small but growing part of big drugmakers’ marketing strategies.

In the past, pharmaceutical companies used these channels as tools to compete with lower-cost generics. But they’ve become more prominent amid pressure from the Trump administration and, more recently, demand for obesity medications that are frequently excluded from private insurance plans. 

TrumpRx is the latest example. In its announcement, the Trump administration highlighted a dozen medicines that will be sold on the site, most of which are for common conditions like obesity, diabetes, asthma, eczema, infertility and osteoporosis. Aside from obesity drugs, Novo’s version of Wegovy for diabetes, called Ozempic, and AstraZeneca’s lung disease medicine Bevespi Aerosphere were the best-selling products included in the White House’s pricing deals. 

More drugs will be added to the site “in coming months,” the administration said.

Drug companies that cut deals with the White House gained a three-year reprieve from pharmaceutical tariffs in return. Notably, those agreements also largely include medicines that aren’t big earners, are already heavily rebated, or are nearing the end of their exclusivity. And the discounts offered, in many cases, don’t represent a better deal than securing drugs through insurance plans, premiums for which are spiking under the current administration. 

“TrumpRx is nothing more than a glorified coupon book, and it will advance the Republican agenda to undermine affordable health care for American families,” said Ron Wyden, D-Ore., in a statement. 

The federal government announced the next 15 medicines for which it will seek price reductions with the help of Medicare’s new negotiating power, including the breast cancer drugs Kisqali and Verzenio and the HIV treatment Biktarvy. Those cuts, which are allowed through the Inflation Reduction Act, will go into effect in 2028. 

Also included in the third annual round of price negotiations were the rheumatoid arthritis medicines Orencia, Cimzia and Xeljanz, as well as Botox when it’s used for therapeutic purposes like migraines. The Centers for Medicare and Medicaid Services designated these drugs for price negotiations under IRA provisions meant to limit expenditures on the drugs associated with the program’s highest costs. 

Combined, the 15 drugs account for $27 billion in Medicare spending and are used by some 1.8 million enrollees. Eli Lilly’s weekly GLP-1 shot for diabetes, Trulicity, is associated with $4.9 billion in annual costs, the highest of any medication on the list.

“CMS is taking strong action to target the most expensive drugs in Medicare, negotiate fair prices, and make sure the system works for patients — not special interests,” said CMS Administrator Mehmet Oz, in a statement. “This approach delivers real savings while strengthening accountability across the program.”

For the first time, these negotiations will include medicines covered by its “Part B” program that involves drugs administered in a physician’s office or other healthcare facility. Orencia, Cimzia and Botox are three examples. 

However, two key drugs that had been previously been expected to make this year’s list — the widely used cancer immunotherapies Keytruda and Opdivo — were left off. The inclusion of both was delayed by at least a year through provisions of the One Big Beautiful Bill Act, which changed the way the IRA program is applied to certain drugs.

The price cuts will, as a result, be “immaterial” for most of the companies whose drugs are on the list, according to Leerink Partners analyst David Risinger. The one exception is Biktarvy, which has Medicare revenue that could represent 8% of Gilead Sciences’ 2027 sales, Risinger wrote in a note to clients.

The exposure for all of the other companies involved comes to 3% or less of overall revenue, Risinger wrote.

Nonetheless, the industry group Pharmaceutical Research and Manufacturers of America railed against the announcement. The group argued that the IRA is “undermining future medical progress” by discouraging investment in new drugs, particularly the chemical, or “small molecule,” drugs that are subject to IRA price negotiations sooner than biologic medications.

“CMS is now planning to set prices for additional small molecule cancer treatments that would otherwise be spared without this penalty – driving even more investment away from these critical treatment options,” said Elizabeth Carpenter, the group’s executive vice president of policy and research, in a statement.

The first round of price negotiations, conducted in 2024, took effect this year.

Eli Lilly responded to a Trump administration plan to lower U.S. drug costs by claiming it will raise prices in European countries to “align” them with the costs paid “across developed countries.”

The effort includes an agreement with the U.K. government to hike the price of the company’s blockbuster diabetes medicine Mounjaro “while maintaining access” for people with the disease, Lilly said.

Lilly didn’t commit to cutting U.S. prices. But it did say that for prices to be reduced in the U.S., the amounts “paid by governments and health systems need to increase in other developed markets like Europe." The company has been working with other, unspecified governments to make other pricing adjustments, too. 

Lilly didn’t specify how it will raise prices in those countries — many of which have nationalized healthcare systems that negotiate drug costs for their entire population — without affecting access. It also didn’t reveal whether the planned hikes would be tied to a drug’s list price or the confidential rebate deals cut between drugmakers and national customers.

The company also pointed out the difficulty of lowering prices in the U.S. because of the healthcare system’s structure.

“The U.S. system is complex and opaque, with multiple cross subsidies, abuse of government programs like 340B, and insurance cost-sharing burdens for patients,” Lilly said.

Through an executive order signed in May, President Donald Trump aimed to link the price paid for drugs in the U.S. to the lowest price paid in other high-income countries. This “most favored nation” policy spurred price negotiations between the federal government and companies, as well as to pushed drugmakers to establish new ways to distribute medicines to patients at a reduced cost.

The “most favored nation” policy came alongside the threat of tariffs on pharmaceuticals, which led many large drugmakers — Lilly among them — to promise to invest billions of dollars in U.S. drug manufacturing.

Drugs imported to the U.S. from the U.K. won’t face tariffs for three years in return for a series of government pricing concessions aimed at balancing the costs paid for drugs in both countries.

An “agreement in principle” that’s part of a broader trade deal between the U.S. and U.K. loosened certain rules that restrain the prices of new medicines in Britain. The pact also reduces mandated rebates to England’s National Health Service from 23.5% to 15% for 2026 through 2028.

In exchange, the U.S. government won’t impose tariffs for three years on British-origin drugs, pharmaceutical ingredients or medical devices under a legal authority known as Section 232.

The agreement helps achieve many of the goals recently outlined by the U.K. pharmaceutical industry’s lobbying group, which has complained that restrictive pricing policies have slowed access to new drugs and discouraged investment. Those policies have irked drugmakers, some of which, including AstraZeneca and Merck & Co., paused spending on British research facilities this year.

The deal will see the U.K. spend 25% more on new medicines by relaxing cost-effectiveness rules set by a pricing watchdog called the National Institute for Health and Care Excellence, or NICE. Under existing rules, NICE deems a drug to be cost-effective if it costs less than 20,000 to 30,000 pounds for each “quality adjusted life year,” or year that a medicine helps alleviate the burden of a disease. NICE is vowing to boost that threshold to 25,000 to 35,000 pounds going forward, and stated that the shift should enable it to approve another three to five new drugs each year.

“The deal is an important step towards ensuring patients can access innovative medicines needed to improve wider NHS health outcomes,” said Richard Torbett, Chief Executive of the Association of the British Pharmaceutical Industry, in a statement. “It should also put the U.K. in a stronger position to attract and retain global life science investment and advanced medicinal research.”

Before the deal was signed, British pharmaceutical manufacturers had already made multiple moves to avoid U.S. pharmaceutical tariffs. AstraZeneca committed to spending $50 billion on U.S. manufacturing and signed a subsequent drug pricing deal, while GSK committed $30 billion to U.S. investments.  

Pfizer and other large pharmaceutical companies are taking seriously President Donald Trump’s demand that drugmakers make more of their medicines available direct to consumers in the U.S. at lower cost, Pfizer CEO Albert Bourla said.

“We have serious discussions in the industry,” Bourla told investors on a conference call in August. “I’m connected very often individually with all the major companies and they are all ready to roll up their sleeves and execute something like that.”

Pfizer and partner Bristol Myers Squibb recently announced plans to offer their widely-used blood thinner Eliquis at a discounted cash price through an online service. The company previously launched a direct-to-consumer service that allows patients to book telehealth appointments, schedule vaccinations and fill prescriptions for certain medicines, such as those Pfizer sells for migraine and COVID-19.

“We think it is a fantastic way to go ahead, so we will work collaboratively to do it,” Bourla said. 

Obesity drugmakers Eli Lilly and Novo Nordisk have also recently opened up more ways for cash-paying patients to access their weight loss medicines directly. Other companies are signaling interest, too, in exploring ways to sidestep pharmacy benefit managers. These drug-purchasing middlemen extract from drugmakers rebates that insurers say they use to lower overall costs, but not necessarily in ways that are obvious to a prescription-filling patient.