Image Source: Pixabay
 

The deal on drug prices between the US Administration and Pfizer will leave the margins of innovative pharma companies intact. Yet, benefits to consumers will be modest. Furthermore, prices for generic medication are still set to increase because of tariffs.
 

What does the Pfizer-Trump deal cover?

The deal between the Trump Administration and Pfizer provides clarity about the near-term future of the US patent-protected pharmaceutical sector after months of (tariff) uncertainty. If companies manufacture and invest in the US, they will be exempt from tariffs. This means that the margin risk from tariffs is largely muted, as branded pharma companies from the US, Europe, and Asia have already announced additional US investments in the next few years.

In addition to providing clarity on tariffs, the Trump-Pfizer deal introduces two new pricing mechanisms, both of which are good news for the industry, but will not substantially lower prices for US consumers. First, a direct-to-consumer (DTC) website will be launched where consumers can buy branded pharmaceuticals at a 50% discount. Second, Pfizer has agreed to lower the prices of its prescription drugs in the Medicaid programme to those in other OECD countries (Most Favoured Nation or MFN pricing). Furthermore, the White House stated that Pfizer will do the same for new innovative treatments: those will be introduced at similar price points in all OECD countries.
 

The DTC part will offer savings to uninsured consumers, squeezing ‘middlemen’

The direct-to-consumer part of the deal will have a limited effect on margins and prices. If the administration were to conclude a similar deal with all branded pharmaceutical manufacturers, which is our expectation, this could yield a potential $1.9 billion in cost savings for uninsured Americans. We arrive at this estimate through the uninsured population size, which is currently 8% and could rise to 10-12% as a result of the One Big Beautiful Bill. So, this measure would roughly benefit 30 million uninsured Americans.

In 2018, the median out-of-pocket spend was $55, but this spending distribution is skewed: a minority pay a lot (e.g. the 95th percentile paid over $1600 in the same year). So, we assume that the mean expenditure is $250 this year and that out of 30 million uninsured people, half will use a prescription drug and the other half will forego a prescription. That yields a potential expenditure of $3.75 billion on prescription drugs by uninsured Americans, of which half would be saved if the Pfizer deal applied to all branded pharma drugs.

So, a total of $1.9 billion in cost savings, which is modest compared to a market size of $590 billion for pharmaceuticals in the US. Still, these cost savings would be realised at the cost of ‘middlemen’ in the US healthcare system, such as Pharmacy Benefit Managers (PBMs), leaving the margins of branded pharma intact.
 

The Medicaid mechanism will have a limited effect on prices and margins

The new Medicaid pricing mechanism also has a limited effect on margins because drugs are often already sold to Medicaid at a substantial discount. Consumers will not see benefits as their out-of-pocket costs are capped (at $8 per prescription for the lowest income Americans). So, the savings would benefit state Medicaid programmes but not consumers.

Then, there are new innovative drugs which will be offered in the US at similar price points as those in comparable countries. However, this already happens, but other governments often do not agree to prices for new treatments as they deem them too expensive. This is the reason why the US is the country that offers the best and most innovative treatments for rare diseases. This could mean that nothing changes: the US is willing to pay high prices for innovative medications that other nations aren’t, which results in better treatment of illnesses but higher medication costs. This part of the deal, therefore, offers some cost savings but will also leave branded pharma margins intact.
 

Price rise of generics will increase costs for consumers

That leaves the generic segment, which accounts for more than 90% of prescriptions and still has to deal with a 30% tariff on China and a 50% tariff on India, where the supply chain sits. Our base case is that these tariffs will remain in place for a prolonged period, meaning prices for generics will gradually increase when stocks run out and contracts are renegotiated. A 50% tariff on India will translate to a price increase for generics imported from the country of roughly 25% as we calculated in earlier articles.

Given that the US imports 47% of its generic prescriptions from India, and generics account for roughly 10% of prescription drug costs. This tariff would increase costs for the US healthcare system by roughly $7 billion and could therefore negate some of the cost savings for uninsured Americans. It will, in any case, increase costs for the US healthcare system as a whole. Moreover, the tariff does not address the strategic dependence on foreign drugs that the Trump administration expressed its discontent with earlier this year.

Given the clarity on the branded segment, the generic space is one we will be watching closely over the coming months.

More By This Author: