MFN Deal Includes Revenue-Sharing With HHS on Overseas Sales

• Public Citizen’s FOIA release of Pfizer’s and Eli Lilly’s “most favored nation” agreements with the White House shows heavy redactions covering termination clauses, covered-drug lists, and revenue-sharing formulas tied to overseas price increases.
• A carveout in Lilly’s deal excludes its top-selling GLP-1 drugs, Zepbound and Mounjaro, from MFN pricing under Medicaid’s GENEROUS model — a gap that Harvard researcher Thomas Hwang estimates could cost Medicaid between $1 billion and $1.7 billion in lost savings in the program’s first year.

Public Citizen obtained heavily redacted copies of Pfizer’s and Eli Lilly’s “most favored nation” (MFN) drug pricing agreements with the Trump administration through a Freedom of Information Act lawsuit, and released its findings September 19. The nonprofit says the documents show terms that help drugmakers raise prices overseas while keeping U.S. prices high, nearly a year after the White House first announced the deals as finished.

The redactions are extensive. Public Citizen said the blacked-out text obscures which Pfizer drugs are actually covered, how MFN prices get calculated, what triggers Pfizer’s right to terminate the agreement, and what happens if Pfizer sells or transfers U.S. rights to a covered drug. The group also flagged that Pfizer’s agreement wasn’t finalized until February 23, 2026 — nearly five months after the administration announced it as done in September 2025.

One provision Public Citizen did manage to piece together: Pfizer will share a portion of any increased net revenue it earns from raising drug prices outside the U.S. with HHS, though redactions hide how much money is involved, which part of the government receives it, or what it can be spent on. Lilly’s agreement has a similarly titled revenue-sharing section, but Public Citizen said its contents are entirely redacted.

Lilly’s agreement also includes a GLP-1 carveout, which defines “covered product” in a way that excludes Zepbound and Mounjaro from MFN pricing under Medicaid’s GENEROUS model, according to Public Citizen. Instead, Lilly’s drugs flow through a separate program called BALANCE, priced at $245 — which Public Citizen says is higher than list prices for the same drugs in some of the reference countries used to set MFN benchmarks. Only Indiana has publicly opted into BALANCE so far, per the group’s release.

The White House’s own account of the MFN program, published a day earlier in a September 18 fact sheet, paints a different picture. The administration said 26 manufacturers have now signed MFN deals, covering 89% of the branded drug market, and cited a Council of Economic Advisers estimate that the agreements will save $600 billion over the next decade — including $64.3 billion in Medicaid savings split between federal and state governments.

The White House also said all 50 states have filed applications to participate in GENEROUS, a detail Public Citizen’s release corroborates, though the group cautioned that filing an application doesn’t commit a state to actually participating. On TrumpRx, the administration said patients have saved more than $700 million since the platform’s February launch, including savings for 600,000 seniors who gained access to GLP-1 drugs at $50 a month. That claim sits alongside the NPR finding, cited in PharmaVoice’s reporting, that only 92 of roughly 800 eligible brand-name drugs are actually listed on the platform. The White House fact sheet also touted one million free Eliquis prescriptions for Medicaid patients under the Pfizer deal — the same drug Public Citizen’s release cites as an example of Pfizer and its partner Bristol Myers Squibb lowering the U.S. list price while still achieving 25% higher net revenue on the drug in the second quarter of 2026 compared with a year earlier.

Separately, PharmaVoice reported that the MFN deals may be cutting into savings the government expected from two unrelated Medicare pricing models, GLOBE and GUARD, set to launch October 1 and January 1, 2027, respectively. Citing an updated estimate from Mass General Brigham researcher Thomas Hwang, PharmaVoice reported the MFN agreements could reduce projected Medicare savings from those two models by nearly 80%, as some drugmakers argue their MFN deals exempt them from the models entirely. A Lancet study had projected the models could save Medicare $11.6 billion annually. Fierce Pharma additionally reported that the White House pointed to previously published fact sheets when asked to respond to Public Citizen’s findings, and that Pfizer said it stands by the deal as “a win for American patients.”