Most Favored Patient Act of 2026
Summary
What This Bill Does
The Most Favored Patient Act of 2026 requires the Center for Medicare and Medicaid Innovation to begin a five-year Most Favored Nations Pricing Model on January 1, 2029. Manufacturers of covered drugs that lack a qualifying agreement with HHS must provide eligible Medicaid, Medicare Part D, Medicare Advantage prescription-drug, Medicare Part B, and Medicare Advantage patients access to a most-favored-nation price. Pharmacies, mail-order services, hospitals, physicians, and other dispensers or providers receive access on behalf of eligible patients.
The benchmark is the second-lowest applicable net price among Canada, Denmark, France, Germany, Italy, Japan, Switzerland, and the United Kingdom. Net price includes rebates, discounts, and concessions and is adjusted for purchasing-power differences. A drug is covered only if it is a qualifying Medicaid, Part B, or Part D drug sold in at least two reference countries during the year.
Manufacturers must report information HHS needs to calculate the benchmark. A manufacturer can avoid specified-manufacturer status by entering an agreement by December 31, 2028, that provides the same price access for one or more drugs, supplies pricing data, and commits to increased U.S. manufacturing. HHS must report agreements to Congress. The Secretary may suspend model requirements for a drug until April 1, 2029, when an agreement appears likely before that date.
Who Benefits and How
Eligible Medicare and Medicaid patients benefit from access to internationally benchmarked covered-drug prices. Medicare prescription-drug plans, state Medicaid programs, and federal Medicare accounts may pay less for covered products. Pharmacies, hospitals, and physicians receive a defined channel for obtaining the benchmark on behalf of eligible patients. U.S. pharmaceutical manufacturing workers may benefit from agreement commitments to expand domestic operations.
Who Bears the Burden and How
Drug manufacturers without covered agreements must lower covered prices to the benchmark and report detailed net-price information, reducing revenue opportunities and adding compliance work. Manufacturers entering agreements must make a domestic-manufacturing commitment. CMMI and CMS staff must calculate purchasing-power-adjusted prices, administer eligibility, receive confidential data, manage suspensions, and report agreements. Plans, pharmacies, and providers must adapt claims and payment systems to the model.
Key Provisions
- Requires a five-year CMMI Most Favored Nations Pricing Model beginning January 1, 2029.
- Provides benchmark-price access to eligible Medicare and Medicaid patients.
- Defines the benchmark as the second-lowest adjusted net price among eight countries.
- Limits covered drugs to products sold in at least two reference countries.
- Requires manufacturers without covered agreements to report pricing data.
- Allows qualifying agreements that include price access and increased U.S. manufacturing.
- Directs HHS to report covered agreements to specified congressional committees.
- Permits temporary suspension through April 1, 2029, when an agreement appears likely.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Requires the Center for Medicare and Medicaid Innovation to run a five-year model beginning in 2029 under which covered-drug manufacturers without qualifying agreements provide Medicaid and Medicare patients access to the second-lowest adjusted net price among eight reference countries.
Key Policy Areas
Prescription Drug Pricing, Medicare, Medicaid, Pharmaceutical Manufacturing, International Reference Pricing, Domestic Manufacturing
Primary Purpose
Requires the Center for Medicare and Medicaid Innovation to run a five-year model beginning in 2029 under which covered-drug manufacturers without qualifying agreements provide Medicaid and Medicare patients access to the second-lowest adjusted net price among eight reference countries.
Policy Domains
Section 2 CMMI international-reference drug-pricing model
Identified Gains
- Medicaid patients receiving covered drugs
- Medicare Part D patients receiving covered drugs
- Medicare Part B patients receiving covered drugs
- State Medicaid programs
- Federal Medicare payment programs
- Pharmacies dispensing covered drugs
- Hospitals administering covered drugs
- U.S. pharmaceutical manufacturing workers
Identified Costs
- Drug manufacturers without covered agreements
- Manufacturer pricing-report staff
- Manufacturers making domestic-production commitments
- CMMI drug-pricing model administrators
- CMS international-price calculation staff
- Prescription-drug plan claims administrators
- Pharmacy payment-system staff
- Hospital billing staff
Sponsors
Legislative Progress
In CommitteeReferred to the Committee on Energy and Commerce, and in …
Introduced in House
Mr. Meuser introduced the following bill; which was referred to …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Drug manufacturers without covered agreements, Manufacturer pricing-report staff, Manufacturers making domestic-production commitments
Positive-direction: U.S. pharmaceutical manufacturing workers
Negative-direction: Drug manufacturers without covered agreements, Manufacturer pricing-report staff, Pharmacy payment-system staff
Medicaid patients receiving covered drugs, Medicare Part B patients receiving covered drugs, Medicare Part D patients receiving covered drugs
CMMI drug-pricing model administrators, CMS international-price calculation staff, Federal Medicare payment programs
Positive-direction: Federal Medicare payment programs
Negative-direction: CMMI drug-pricing model administrators, CMS international-price calculation staff
Hospital billing staff, Prescription-drug plan claims administrators
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "secretary"
- → HHS Secretary administering benchmark calculations and agreements
- "eligible_individual"
- → Covered Medicaid, Part D, Medicare Advantage, or Part B patient
- "specified_manufacturer"
- → Covered-drug manufacturer without a qualifying agreement with HHS
Key Definitions
Terms defined in this bill
A timely manufacturer agreement providing benchmark-price access and data and committing to increased U.S. manufacturing.
A specified Medicaid, Part B, or Part D drug sold in at least two reference countries during the year.
The second-lowest purchasing-power-adjusted applicable net price for the covered drug among the reference countries.
Canada, Denmark, France, Germany, Italy, Japan, Switzerland, or the United Kingdom.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology