Most Favored Patient Act of 2026

The bill orders the Center for Medicare and Medicaid Innovation (CMMI) to run a new payment model called the “Most Favored Nations Pricing Model” starting January 1, 2029. This model would last for 5 years and would apply to certain drugs that are sold in at least two listed “reference countries,” such as Canada, Germany, Japan, and the United Kingdom. These drugs include many outpatient drugs, Medicare Part B drugs, and Medicare Part D drugs. Under the model, each drug manufacturer that does not have a special “covered agreement” with the government must give eligible patients and providers access to a “most‑favored‑nation price” for each covered drug. For people getting drugs at a pharmacy, mail order, or other dispenser, the discount would go to Medicaid patients and people in Medicare drug plans when their plan covers that drug. For drugs given in a hospital, doctor’s office, or other provider setting, the discount would go to people covered under Medicare Part B. Manufacturers must also report to the Secretary of Health and Human Services whatever pricing information is needed to calculate the most‑favored‑nation price. The bill defines the “most‑favored‑nation price” as the second‑lowest average net price that the manufacturer receives for the drug in any of the reference countries. This price takes into account rebates, discounts, and other price breaks, and is adjusted for differences in purchasing power between those countries and the United States. The bill also defines key terms such as which countries count as reference countries, which drugs are included, and who qualifies as a most‑favored‑nation price eligible individual. The bill creates an option for drug makers to sign a “covered agreement” with the Secretary by December 31, 2028. Under such an agreement, a manufacturer promises to provide most‑favored‑nation pricing and required reporting for one or more of its drugs, and also commits to increasing its manufacturing operations in the United States to the Secretary’s satisfaction. The Secretary must report these agreements to key committees in Congress by certain dates. If the Secretary reasonably believes a manufacturer is likely to sign such an agreement before April 1, 2029, the Secretary may delay applying the model’s requirements to that manufacturer’s drugs until that date.