By NextBestFitNational negotiation for all drugs
One national body negotiates prices for every drug, using international prices and value assessments as benchmarks.
National negotiation for all drugs, tied to added benefit.
To review: Weigh savings against slower launches and some lost R&D (CBO: about 59 fewer drugs over 30 years for H.R. 3).
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This path
National negotiation for all drugs
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Extend national negotiation to all drugs for all payers
- Use international prices and added-benefit assessments as benchmarks
- Apply an excise tax or exclusion if manufacturers refuse to negotiate
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Brand-name drug prices far above production cost
National negotiation uses international prices and value assessments to obtain large savings and a uniform drug price across locations.
What it creates or worsens
- Slower access to new drugs and technology
National price negotiation lowers manufacturer revenue, which may reduce some research and development.
3 paths soften this
Cover new treatments at launch, then reassessSlower access to new drugs and technologyChosenRecycle part of drug savings into researchSlower access to new drugs and technologyChosenRequire timely U.S. launch as a condition of market accessPrice limits can cause shortages, launch delays, or exitsRejected - Price limits can cause shortages, launch delays, or exits
National price negotiation may lead manufacturers to delay drug launches.
3 paths soften this
Price floors and supply guarantees for essential productsPrice limits can cause shortages, launch delays, or exitsChosenMonitor supply and adjust prices quicklyPrice limits can cause shortages, launch delays, or exitsChosenRequire timely U.S. launch as a condition of market accessPrice limits can cause shortages, launch delays, or exitsRejected - Central coverage decisions can feel like rationing
A national negotiating body uses value assessments as benchmarks for drug prices, placing those assessments within a national decision process.
3 paths soften this
Independent, transparent coverage body with appealsCentral coverage decisions can feel like rationingChosenCover everything clinically effective, without cost thresholdsCentral coverage decisions can feel like rationingRejectedClinician-led exceptions with fast reviewCentral coverage decisions can feel like rationingChosen
Who's affected
Who gains
- People with unaffordable deductibles or coinsurance
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Uninsured people
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Health insurers, brokers, and their shareholders
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Slower access to new drugs and technology: Strict value assessment lowers payment for new products in the short run.
- Taxpayers and public budgets
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Slower access to new drugs and technology: Strict value assessment lowers payment for new products in the short run.
- Price limits can cause shortages, launch delays, or exits: Low price limits reduce spending in the short term.
- Central coverage decisions can feel like rationing: Declining low-value care holds down public spending.
- People with ongoing or specialist care needs
- Brand-name drug prices far above production cost: National negotiation uses international prices and value assessments to obtain large savings and a uniform drug price across locations.
Who loses
- Drug and device makers
- Brand-name drug prices far above production cost: Market exclusivity supports high prices and shareholder returns.
- Slower access to new drugs and technology: Lower prices reduce research returns for biotech workers and investors.
- Central coverage decisions can feel like rationing: A declined product loses the whole national market.
- Pharmacy benefit managers and their pharmacies
- Brand-name drug prices far above production cost: High list prices generate rebates for benefit managers.
- People with ongoing or specialist care needs
- Slower access to new drugs and technology: Strict value assessment can delay or refuse new therapies.
- Price limits can cause shortages, launch delays, or exits: Low price limits may reduce access to products and services through shortages or exits.
- Central coverage decisions can feel like rationing: People needing a declined or delayed treatment have no other insurer to turn to.
Other ways to soften the losses
- Link prices to added benefit so true innovation is still rewarded
Where it has been tried
- U.S. Medicare negotiation (IRA): First negotiated prices took effect in 2026.Sources: CMS (2024)
- Germany (AMNOG): Free launch price for one year, then a negotiated price based on added benefit.
Costs this path changes
Works well with
Public drug formulary and direct pricingPharmacy benefit managers profit from opaque drug pricingChosenKeep the current patent systemPatent thickets and evergreening delay genericsRejectedValue-based prices that reward real innovationR&D is funded by high prices, which ties innovation to unaffordabilityChosenCover new treatments at launch, then reassessSlower access to new drugs and technologyChosen