Universal HealthcareBy NextBestFit
Phase 1: Enactment & build · Step 1.9

Create the national formulary & negotiate drug prices

Months 0–18 for the initial formulary; continuous negotiation · National Formulary and Pricing Board; HTA InstituteDiscuss this step
marketlikelihood: mediumimpact: medium

Larger-than-expected drop in drug innovation

Lower U.S. prices reduce global R&D investment more than CBO-style estimates predict.

Early warning signs
  • Venture funding for biotech
  • Phase I trial starts
  • U.S. launch delays
Mitigation
  • Value-based pricing that rewards breakthroughs
  • Increase NIH/BARDA funding

Implementation risks

RiskMitigation
Manufacturers withdraw drugs from the U.S. market.§1498 authority; the U.S. is about 45% of global pharma revenue, so withdrawal is costly for manufacturers.
Trade retaliation or treaty disputes over §1498.Use §1498 sparingly as a backstop; TRIPS Article 31 permits government use with compensation.