“A high-level Pfizer manager went on record and said: if they had to choose between lowering prices in the US or not launching in France — they would not launch in France.”
Christoffer Frendesen, EU correspondent for Dagens Pharma and former European Parliament policy advisor, raises serious concerns about a policy shock that many in Brussels are still reluctant to confront directly.
Christoffer covers health, pharma, and life sciences policy from Brussels, with over five years of experience as a policy advisor to Danish MEPs inside the European Parliament. His close proximity to both legislative process and industry reaction gives him a well-informed perspective on the real-world consequences of US drug pricing reform on European markets.
In this episode of the PharmaSource podcast, Christoffer explains why Trump’s Most-Favored-Nation (MFN) executive order, signed in May 2025, is not just an American story, and why pharmaceutical executives, market access teams, and patient advocates across Europe need to be paying close attention right now.
MFN Policy Overview
The MFN executive order directs the US Department of Health and Human Services to align American drug prices with the lowest prices paid for equivalent medicines in comparable high-income nations. The logic is simple: the US currently pays up to three to four times more for the same medicines, often manufactured in the same facilities, as patients in France, Denmark, or the UK.
If those European reference prices become the ceiling for US pricing, the commercial calculus for pharmaceutical companies changes fundamentally, and the consequences ripple outward.
“The uncertainty creates considerations on where to invest, where to launch, and when,” Christoffer explains. “Nothing is certain yet, but it definitely leads to considerations on potentially delaying the launch of medicines and potentially also considerations on whether it’s possible to increase prices.”
Three Likely Consequences for European Markets
Based on conversations with multiple companies, trade associations, and independent experts, Christoffer identifies three probable outcomes that European pharma executives should be modelling now.
Delayed launches
If a company launches a new drug in France before it reaches the US market, that French price risks becoming the MFN reference price that caps US revenues. The financial incentive to sequence launches to the US first, then Europe later is significant. For some medicines, “later” could mean months. For others, it could mean years.
Price increases
With US margins potentially compressed, companies will look to recover profitability elsewhere. Multiple sources have told Christoffer that passing lower US margins on to other markets is being actively considered. European pricing and reimbursement teams should anticipate intensified negotiations with manufacturers.
Market withdrawals for some countries
The most severe consequence is that some medicines simply never reach certain European markets. Christoffer notes that an executive from Pfizer said that if they “had to choose between lowering prices in the US or not launching in France, they would choose not to launch in France.” For smaller member states with limited purchasing power and population size, the calculus is even harsher.
Patient Access
Delayed launches could mean delayed access to potentially life-changing or life-saving therapies.
Christoffer is careful to note that this problem is not new to Europe. Significant disparities in medicine availability already exist between larger markets like Germany and France and smaller member states. The MFN policy risks deepening those fault lines. “This could make an existing disparity even worse,” he says.
Industry Response
A recent survey of European SMEs found that a majority of respondents were considering delaying launches as a direct result of MFN uncertainty, with some considering full withdrawal from certain member states. The US is the most important export market for many of these businesses, accounting for a significant share of profits.
Christoffer urges a degree of scepticism about the most extreme positions. “A lot of companies are using this moment to send a signal to policymakers — saying: we need higher prices, otherwise we might not give you the medicines you want.” That dynamic is real, but so is the underlying commercial pressure. Even experts who believe companies could sustain investment in R&D at lower US price points acknowledge that accepting reduced profitability without passing costs elsewhere is unlikely.
The MFN agreements already signed between the Trump administration and at least 16 pharmaceutical companies, which reportedly include commitments to invest in US domestic manufacturing, add a further layer of complexity for companies weighing their European strategies.
What Brussels Is — and Isn’t — Doing
The European Commission’s public response to date has been cautious to the point of paralysis. It has repeatedly stated that it is “monitoring the situation.” Christoffer’s own reporting suggests that member state representatives in Brussels have not yet coalesced around a clear ask for Commission action, and that the Commission itself is wary of any move that could be read as a direct confrontation with the Trump administration.
The structural challenge compounds the political one: pricing and reimbursement authority sits with individual member states, not Brussels. Getting 27 governments to align on a coordinated response, let alone to cede national control over healthcare pricing to a single EU-level process, is, as Christoffer puts it, “very close to unlikely at this point.”
One academic expert he spoke to suggested that external pressure from MFN could, create the political conditions for greater EU-level coordination on market access — potentially a single pricing and reimbursement pathway that would make Europe a more attractive and administratively efficient market for manufacturers. It remains theoretical for now.
Within the European Parliament, the head negotiator on the Critical Medicines Act has pushed for stronger local production criteria in procurement rules — requiring that active pharmaceutical ingredients be manufactured within the EU. The proposal is contentious within the industry, given that approximately 75% of APIs are currently produced in India or China, and European production would add significant cost. New Commission procurement rules expected imminently are likely to include a heavy emphasis on local manufacturing incentives.
What Pharma Executives Should Watch Over the Next 12 Months
Christoffer identifies three things to monitor closely.
First, watch whether the Commission makes any formal statement or proposal that, while not explicitly framed as a response to MFN, addresses the downstream risks — delayed launches, pricing pressure, or manufacturing resilience. “It will be clear that it’s a response, even if they don’t say so directly,” he says.
Second, watch whether European companies begin to coordinate collectively in their engagement with the Trump administration, rather than negotiating bilaterally. That approach has not materialized yet, but could if MFN agreements continue to proliferate.
Third, and most fundamentally, watch the durability of the MFN policy itself. Christoffer notes that future US administrations, regardless of party, will face the same underlying pressure on drug pricing. A policy that demonstrably lowers costs for American patients is unlikely to be reversed, even if its implementation evolves. That makes the structural adjustment for European markets a medium-term strategic reality, not a short-term political cycle to wait out.
“I would definitely bet yes — European patients will feel this,” he says. “The question is not if, but how much.”
