AstraZeneca joins Pfizer in most-favored nation pricing program

Pricing impact

Uninsured Americans who are not eligible for manufacturer copays are expected to see the most out-of-pocket savings from the MFN agreements so far.

Privately insured patients, however, are unlikely to see much change in what they already pay. Every drug included in the MFN pricing model is already available to commercially insured patients at deeply discounted rates -- or at no cost -- through existing copay savings programs.

Every state Medicaid program will have access to MFN-level prices, the White House said, though the impact on beneficiaries remains uncertain. Medicaid enrollees already pay minimal copays, with out-of-pocket costs depending on their plan's negotiated formulary pricing rather than the list price of a drug.

Although MFN pricing has the potential to indirectly lower Medicare Part D spending, the savings are not expected to reach beneficiaries, considering the drugs listed so far are not major Medicare cost drivers.

MFN drug pricing

Eucrisa (crisaborole)

Eucrisa is a topical ointment made by Pfizer to treat mild to moderate atopic dermatitis in adults and children as young as three months old. A 60 g tube of 2% Eucrisa can cost close to $1,000 on GoodRx without a discount coupon.

However, Pfizer’s Dermatology Patient Access program caps patient costs at $10 per tube for those with commercial insurance coverage and $100 for those whose plans exclude it. Individual savings are capped at $970 per tube or $3,880 per year.  

Eucrisa will be sold at 80% less than its list price through direct purchase, the White House said.

Xeljanz (tofacitinib)

Pfizer's Xeljanz is an oral Janus kinase (JAK) inhibitor approved for treating rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. A 30-day supply of 10 mg tablets costs over $3,000 without insurance on GoodRx.

With Pfizer's copay savings card, eligible commercially insured patients can pay as little as $0, with a maximum annual benefit between $4,000 and $15,000, depending on insurance coverage. Xeljanz will be available at a 40% discount off the list price for direct buyers.

In 2024, Xeljanz generated nearly $1.2 billion but accounted for only 2% of Pfizer’s total revenue ($63.6 billion).

Zavzpret (zavegepant)

Zavpret, a prescription nasal spray used for the acute treatment of migraines, retails on GoodRx for just over $1,000 per box of six 10 mg spray bottles.

Pfizer's copay savings card allows eligible, commercially insured patients to obtain the patented drug for as little as $0 per month.

For those purchasing directly without insurance, Zavzpret will be sold for half of its list price.

Bevespi Aerosphere (glycopyrrolate/formoterol)

AstraZeneca's Bevespi Aerosphere is a long-acting bronchodilator inhaler used for maintenance treatment of chronic obstructive pulmonary disease (COPD). GoodRx data show that the average retail price of one inhaler is $548.

Through AstraZeneca's savings program, eligible commercially insured patients can receive the inhaler at no cost, with a maximum savings limit of $100 per inhaler per month.

Bevespi will be discounted for direct buyers, but by how much is unclear after the White House said it would be "a discount equal to 654% of the deal price," which isn’t mathematically possible.

Last year, Bevespi brought in $504 million, which was less than 1% of AstraZeneca’s total revenue of $54.1 billion.

Breztri Aerosphere (budesonide/glycopyrrolate/formoterol)

Breztri Aerosphere, a triple-combination inhaler approved to treat COPD, costs around $644 per inhaler without insurance on GoodRx, but AstraZeneca's Zero Pay savings program allows privately insured patients to pay as little as $0, if eligible.

The price of Breztri will be discounted by 98% for patients purchasing directly through the program.

In 2024, Breztri earned $1.1 billion, representing around 2% of AstraZeneca’s overall revenue from product and collaboration sales.

Airsupra (albuterol/budesonide)

Airsupra is a dual-action inhaler approved to relieve asthma symptoms and prevent acute attacks. The rescue inhaler's average retail price is nearly $600, though eligible patients can obtain it for free through the company’s Supra Savings card, which provides up to $130 in savings per fill.

Under MFN pricing, Airsupra will be sold at a 96% discount off the deal price.

Last year, Airsupra generated $66 million, roughly only 0.1% of AstraZeneca's total revenue.

The established agreements with AstraZeneca and Pfizer give the MFN prescription drug pricing program momentum, but the real-world impact could be smaller than expected, depending upon which companies join next and which drugs they choose to bring to the table.

If the MFN products offered through TrumpRx aren't widely prescribed or used by large patient populations, the program could fall short of delivering the sweeping savings the White House has envisioned.

Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.