What Do the New MFN Deals Lock In?

Former U.S. Representative Joe Cunningham (D-SC) and spokesperson for the Pharmaceutical Reform Alliance, cautions that the new Most-Favored-Nation (MFN) pricing agreements are executive actions that carry only the weight of the paper they're written on, since a future administration could come in and completely overhaul them.

He argues that any lasting change capable of actually lowering prescription drug costs, or putting more money back in people's pockets, has to be codified into law through Congress rather than left to executive order, which by nature expires once a president's term ends. Cunningham applauds the current agreements as a first step, but not to view them as a finished or durable solution.

That same instability, he explains, extends directly into how the agreements handle structured pricing. The current MFN executive order covers Medicaid but omits the commercial sector, which makes up roughly 80% of Americans. Cunningham pushes back on the notion that rebates, bundled contracts, and net pricing arrangements make the problem too complex to regulate, comparing it to other complicated sectors, such as AI and social media, that the government does not simply decline to oversee. In his view, some companies lean on that complexity deliberately, using varied pricing structures to muddy the waters and obscure their actual net prices from scrutiny.

Cunningham returns to a single fact he treats as decisive: Americans pay roughly three times more, on average, than consumers in other developed nations for the same drug. For him, that gap is the clearest evidence that the system can and should be brought into line, but doing so, whether by closing the commercial-sector gap or making pricing rules stick beyond a single administration, requires the combined, codified work of Congress and the president.