Big Pharma financially unfazed by drug price deals

The big picture: Although details of the deals involving more than a dozen leading drug companies are confidential, the industry has made concessions on some prices in exchange for more regulatory certainty — with little to no noticeable impact on the bottom line.

• "If you have engaged in something that materially changed your outlook, you have to communicate that," said Rob Smith, managing partner at Capital Alpha. "The fact that they're not saying much kind of tells you what you need to know."
• Centers for Medicare and Medicaid Services administrator Mehmet Oz at a PhRMA event earlier this week suggested the pricing deals were accommodating to manufacturers.
• "I don't want to hurt innovation," he said. He noted that much of the price adjustments were for Medicaid, where "prices are lower anyway, so it's less hurtful; the sector did OK, we believe."

What they're saying: "Strategic actions in 2025 helped us resolve significant uncertainties, including achieving greater clarity on pricing and tariffs, and demonstrating the underlying resilience of our business," Pfizer CEO Albert Bourla said on the company's Q4 earnings call early this month.

• Some companies simply said the deals had been baked into their 2026 outlooks.
• Gilead described any drag on earnings as "manageable," noting that the deal it cut with President Trump plus changes to the Affordable Care Act will impact its flagship HIV business by about 2% in 2026.

The other side: The outliers were Novo Nordisk and Eli Lilly, the manufacturers of popular new anti-obesity drugs, who portrayed the deals they struck as more impactful.

• Both companies agreed to lower cash-pay prices for their GLP-1s in exchange for Medicare coverage of the drugs for certain populations. And because many patients pay out-of-pocket for anti-obesity medications, price reductions are meaningful.
• Lilly said in its earnings call that while lower negotiated prices had a negative impact on its financial outlook, the concessions will be more than offset by the larger population of people able to access the drugs.
• Novo Nordisk cited the price concessions as part of why it is forecasting a decline in sales this year, though it is also losing market share to Lilly.

Yes, but: While the voluntary White House deals may be tolerable for the industry, it's made clear that any effort to write "most favored nation" pricing into law would not be.

• Trump has asked Congress to pass such a law and tie U.S. drug prices to the lowest prices paid in certain other developed nations.
• That would go much further than voluntary cuts to Medicaid drugs — which manufacturers already heavily discount — and future drug launches.

"President Trump has been clear about the need to reduce unfair drug pricing for American patients without undermining lifesaving innovation," said White House spokesperson Kush Desai.

• "That's why the Trump administration is ensuring that price cuts for American patients are followed by other wealthy countries finally paying their fair share for global pharmaceutical research and development."

What we're watching: The drugmakers themselves may still be figuring out what they agreed to.

• "If you don't have a huge amount of certainty around how the policy's going to evolve, you're not going to release a precise measurement," said Kirsten Axelsen, a life sciences consultant.
• "There's no term sheet for these deals, they were press releases," she added. "So it may also be that it's too soon to say with certainty, because we don't know what the impact is one way or another."