The most important issue the industry faces is healthcare and drug pricing. With 2026 being a key election year, regulators are giving the issue more attention than usual.

While the Republicans hold power at the moment, it’s unclear what will happen during the midterms later this year, with Democrats hoping to take back at least one house of Congress. As such, the current administration is attempting to take multiple actions to show the public it can reign in healthcare costs.

Primarily, the President has pushed two main agendas: most-favored-nation pricing and tariffs on imported goods.

During the Asembia AXS26 Summit in Las Vegas, multiple pricing experts convened for a panel on this issue and where it stands ahead of the midterms. The panel included:

• Mina Allo, managing director of Avalere Health
• Mike Ciarametaro, managing director of Avalere Health
• Lisa Joldersma, senior advisor of Avalere Health

Click here for the rest of our Asembia ASX26 Summit coverage!

How are tariffs and MFN pricing impacting drug prices?

Joldersma kicked off the conversation with a focus on PBM reform, which she says has seen significant activity in the last six months. Specifically, she focused on action taken against Express Scripts, which saw the FTC investigate alleged non-competitive activity that resulted in higher costs of insulin.

“Similar action was brought against Optum RX and CVS Caremark as well, Joldersma explained. “CVS has indicated that it has reached preliminary terms that may be settlement with the FTC, but the title of its final terms are currently redacted if you try to go and look them up.”

She continued, “This is a fairly significant announcement. Many people would ask how it is different from what the PBM industry has announced that it was going to do voluntarily already. You may recall that Cigna ESI made an announcement in October of some voluntary actions they were taking. And the settlement here builds on that voluntary announcement.”

She then discussed how extensive reporting has been done on commercial data that would go to sponsors. According to her, this relates to the requirement for de-linking, which means that compensation to the PBMs must be based on a fee structure as opposed to rebates.

“I would characterize these as settlement terms that read the room and understood what people will were calling for, with one huge caveat: there was an act so the PBM is required to abide by these requirements in their standard product offerings only,” she said. “What that means is if an employer looks at the standard offering and they like the way they’ve been doing things all along, they are able to do that.”

What other regulatory issues are impacting pharma drug pricing?

Allo then jumped in to go into more detail about de-linking, which she says is an area she’s seen some asymmetric action occurring in.

“As manufacturers, this is something that you'll have to really monitor closely and certainly explore with your plan sponsors,” she said. “The other piece is the section 11 loophole that employers plan sponsors can have with an FTC deal. This allows employers to say that they don't want to participate in certain offerings.”

Allo continued, “When we think of the employer channel in general, how many employers currently on the ESI standard offering have moved towards the ESI standard offering? FTC did require $10 million worth of marketing that ASI would have to push towards encouraging folks to sign up to the standard offering. So, watching the employer market evolve from high revenue to the lowest net cost is something that will be monitored.”

Ciarametaro discussed various efforts by the Trump administration to tackle high healthcare costs, specifically on the pharmaceutical side. Some of these efforts have directly focused on drug prices, while others are attempting to push manufacturers to bring their facilities back to the US and focus less on importing foreign goods and products.

“The most recent push on the regulatory side is the move forward with MFN,” he explained. “At the same time, the administration is trying to codify that to statute. That that would happen by the reconciliation process, and currently there's not enough support to pass that through Congress. There's a lack of openness on the Democratic side. So, in terms of codifying through reconciliation, that's probably less likely.”

Ciarametaro continued to go into more detail on the administration’s efforts regarding domestic manufacturing and production. In early April of this year, the Trump administration announced severe tariffs for patented pharmaceutical imports. However, exemptions were made for companies that made deals with the administration as part of its MFN pricing initiative.

Further complicating the tariff situation are deals made with specific countries and regions. For example, the administration signed a deal with the European Union for 15% tariffs on all goods, which supersedes the regulations on pharmaceutical tariffs.

Some tariffs have faced significant legal challenges, so the regulatory future of these efforts remains unclear.

He continued, “The most significant thing, though, is manufacturers that aren't included as part of those deals. How are they going to react? That is probably the single biggest driver of determining whether this moves forward. If those manufacturers decide to push back that process, the entire process could be delayed. Negotiations are underway. That's the opportunity this year. The thing that everybody's focused on.”