Body: The Trump administration's "most favored nation" agreements for direct-to-consumer drug prices available through TrumpRx are not always the lowest prices available in comparable countries, a new KFF analysis found, despite the White House's promises to achieve the best prices in the world for American patients. For slightly under half the brand-name drugs included in the analysis, the TrumpRx price is higher than the average publicly listed price among Organization for Economic Co-operation and Development countries, and for some drugs TrumpRx offers the highest public OECD price. KFF’s Sept. 24 analysis found that among 32 brand-name drugs available on TrumpRx that have no generic competition and have public price information from one or more of 11 OECD countries, the TrumpRx price is higher than the average price in other countries for 15 of 32 drugs. For the other 17, the TrumpRx price is lower than the average in other OECD countries. But the price was the lowest publicly available for only five of the 32 drugs, while it was the highest publicly available in 13. The Trump administration has touted its MFN deals with major pharmaceutical companies as offering Americans the best prices among developed countries for the drugmakers' products. But the terms of the deals have not been made public, promoting skepticism and calls for increased transparency from many lawmakers. The agreements are also set to expire at the end of President Donald Trump's term. The analysis came ahead of state Medicaid agencies’ deadline Wednesday (Sept. 30) to decide whether to participate in the administration’s GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model, a CMS innovation center model in which participating drug companies will provide states with supplemental rebates for certain drugs to closely align their Medicaid net prices with the low prices in other wealthy nations. The model will test whether a form of MFN pricing can effectively bring down the program’s drug costs. Neither the GENEROUS model's methodology for calculating MFN prices nor the methodology used to reach the prices available on TrumpRx has been made public, so the two price points may differ. President Donald Trump announced earlier this month that all 50 states, Washington D.C. and Puerto Rico had at least applied to take part in the model. But because many questions pertaining to the pricing and operation of the individual manufacturer MFN deals, the GENEROUS model and other MFN initiatives remain unanswered, consumer groups, drug price reform advocates and lawmakers are unconvinced MFN pricing from the deals or from the administration’s CMS models will result in lasting, lower drug spending in the United States. The KFF analysis says that as more drug companies sign on to provide purported MFN pricing for their products through agreements with the Trump administration, the overall effect on domestic drug pricing remains uncertain. It is possible the prices of drugs in United States could change to more broadly reflect the lower prices in other countries, but is also possible drug companies will simply increase prices in other countries, which Trump has also pushed for, the analysis says. The analysis also comes as CMS finalizes another innovation center demonstration to apply MFN pricing methodology to the inflation rebate program for Part B drugs -- the Global Benchmark for Efficient Drug Pricing (GLOBE) model. But that model is now also expected to yield less savings than initially touted by the Trump administration after CMS exempted several drug types and waived participation for any companies already participating in the GENEROUS model. Drugs selected for Medicare price negotiations are also expected to leave the GLOBE model whenever the new, negotiated prices kick in. Some stakeholders previously supportive of the GLOBE model are disappointed with the exemptions, as the model was first projected to save Medicare $11.9 billion over seven years last year but is now projected to save 96% less than that at $440 million. Allowing certain companies to waive participation also leaves only four companies expected to take part in the GLOBE model. Patients For Affordable Drugs is one of several stakeholders that had submitted comments to CMS earlier this year asking the agency not to exempt any drug companies from the GLOBE model because projected savings would drop significantly and the overall impact of the test would be flattened. “Drugmakers have secured carveouts that dramatically shrink the reach of GLOBE, while patients on Medicare Part B can still face 20 percent coinsurance for some of the most expensive drugs administered in a doctor’s office with no annual out-of-pocket cap that protects them from these costs,” P4AD Executive Director Merith Basey said in a statement Thursday (Oct. 1). “GLOBE was designed to lower those prices and what patients pay, but these pharma-friendly carveouts have undermined that promise. The administration should reverse course and ensure GLOBE delivers the savings it was designed to achieve for patients and taxpayers.” -- Gabrielle Wanneh ( gwanneh@iwpnews.com )