If You’re a Market Access Lead in 2026: How to Navigate the Toughest Pricing Pressures in a Decade

In 2026, U.S. policy shifts will link domestic US prices to international markets. At the same time, affordability pressures will continue to exert downward pricing pressure in Europe and beyond.  

The implication is clear: pharma can no longer view the U.S as a global “price safety net”, and strategy needs to shift from maximising list price on a market-by-market basis, to proactively protecting pricing corridors globally. 

For market access leaders in 2026, the biggest risk is rarely a single policy in isolation, but rather spillover across reference markets and the subsequent ripple effects on local dynamics and patient access. 

In this article, we will cover 

• Key pricing policies and their impact on the 2026 pricing drivers 

• How MFN and IRA scenarios can spill over into reference markets 

• How affordability impacts European pricing strategy and beyond 

• Direct versus indirect factors that will influence global price corridors and launch strategy 

Value, Affordability, and Reference Pricing: The Three Forces Reshaping Global Drug Pricing in 2026 

Pricing pressure has been steadily building over the past decade and has now become structural. In the U.S., international price referencing resurfaced through the Most Favoured Nation (MFN), while the Inflation Reduction Act (IRA) introduced Medicare price negotiation.  

Outside of the U.S., the global pricing environment has become more difficult to navigate, especially due to cost-containment policies, especially in Europe, where subsequent waves of pharmaceutical innovation have challenged the sustainability of publicly funded universal healthcare systems.  

In 2026, the developing connection between prices achieved in Europe and those set in the U.S. will lead to a significant shift in the pricing strategy narrative – from ‘where can we win early?’ to ‘where can we launch without collapsing our U.S. pricing?’ – as such, there are several strategic areas that will see greater scrutiny:  

• The value component: has been under sustained scrutiny since the mid-2010s as payers pushed for value-based pricing and outcomes-linked agreements (often via managed access or managed entry agreements). Systems like NHS England’s commercial frameworks and Italy’s AIFA registries illustrate how value uncertainty translates into conditional access and commercial terms [1,2].  

• The affordability component: has been intensified through explicit budget impact and clawback mechanisms (for example, the UK’s VPAG payment percentages) and broader EU efforts aimed at sustainability and affordability [3,4]. 

• The international price reference component: has become more prominent as external reference pricing remains widespread and the MFN in the U.S. imposes a ripple effect on pricing policies in “reference markets” — making it imperative that manufacturers ensure list price discipline, confidentiality where possible, and careful launch sequencing that avoids creating low anchors and undermining value globally. 

When U.S. Drug Pricing Risk Becomes Reality — How IRA and MFN Are Rewriting the Rules 

In 2026, IRA drug price negotiations will become a clear behavioural inflection point, as negotiated prices move from theoretical risk to observable market reality. Even for assets not yet in scope, the signal is unambiguous: high-spend products face earlier scrutiny, greater sensitivity to both launch list prices and post-launch increases.  

Concurrently, the MFN adds pressure in the U.S. by effectively anchoring prices to European and other established markets. However, to what extent the reference pricing will be policed (either through informal rules or newly enacted laws) remains uncertain. As the formal execution of the MFN policies is being decided, manufacturers should prepare for a set of risk scenarios: 

• A ‘soft’ MFN environment can emerge through payer deals, public pressure and benchmarking narratives that encourage alignment with international prices without formal rules.  

• A ‘targeted’ MFN approach could apply to specific channels, populations or product categories, concentrating pressure where spend or political attention is highest.  

• A ‘broad’ MFN scenario would better and more formally align US pricing expectations with international benchmarks.  

Currently, MFN is proposed to the American Congress through “The Great Healthcare Plan” which would codify the Most Favoured Nation policy, bringing it closer to the ‘broad’ MFN scenario [5]. 

When U.S. Pricing Moves, the World Reacts: Understanding the Global Spillover Effects 

Globally, we anticipate recent U.S. pricing policies to generate indirect but material spillovers through three distinct pathways. While the Inflation Reduction Act (IRA) does not formally reference international prices, and MFN-style proposals are most likely to rely on public price proxies rather than true net prices, the combined effect is a structural shift in how global prices interact. 

Spillover pathway 1: Reference markets become implicit U.S. pricing inputs 

• If the U.S. explicitly (through MFN-style policies) or implicitly (through political, payer, or public benchmarking narratives) anchors expectations to international prices, low published prices in benchmark markets can rebound back into U.S. pricing pressure. 

• For global teams, this fundamentally changes how markets historically considered “easy wins” or “fast launches” are treated, as early list prices increasingly influence downstream U.S. optionality. 

Spillover pathway 2: The IRP web makes secondary ripple effects unavoidable 

• Beyond the U.S, IRP creates an interconnected pricing web in which a single low anchor can propagate across multiple markets. 

• While confidential discounts may protect local net prices, published list prices continue to shape outcomes, requiring global teams to assess whether early list price decisions could cascade into second-order effects across the portfolio. 

Spillover pathway 3: Payer expectations converge even without formal referencing 

• Global pricing pressure is no longer driven by policy alone; it is also driven by perception. Payer narratives increasingly travel across borders, reinforcing expectations that new medicines should deliver comparable economic value internationally. 

• This dynamic can enable “international fairness” arguments, where foreign prices are used to harden negotiating positions and reduce tolerance for pricing outliers. 

Spotlight on Affordability: Why Global Pricing Has Become a Systemic Risk 

In Europe and beyond, price communicability dynamics are reinforced by affordability and sustainability mechanisms that narrow the room to manoeuvre. Here are some recent developments that illustrate a trend for tightening pricing corridors globally: 

• UK: Under VPAG, recent payment rates for newer medicines have been high (e.g., around 22.9% in 2025), and while the 2026 rate is set to fall to 14.5%, the scheme continues to shape how global teams think about UK net price exposure, list price signalling, and discount architecture when protecting a wider corridor [3,6].  

• Germany: The Medical Research Act (Medizinforschungsgesetz) enables confidential reimbursement amounts, intended in part, to reduce international spillover from Germany’s historically visible pricing signals. However, this also adds complexity to launch planning, price communication, and governance [7,8].  

• Canada: The PMPRB is tightening its approach to identifying “excessive” patented medicine prices through new Guidelines that took effect on January 1, 2026, including screening using international comparator pricing (PMPRB11) and additional review steps where relevant. This raises the bar for sustaining premium positioning and defending price levels over time [9].  

• Japan: Ongoing reforms (including FY2024/FY2025 measures) combine incentives for certain innovations with continuing post-listing repricing dynamics, increasing uncertainty around the post-launch price trajectory and, in turn, expected lifetime value [10].  

• Middle East: In some launch strategies, selected Middle East markets are being evaluated earlier as alternative sequencing options as the US/EU become tougher early anchors — but this can introduce new trade-offs around visibility, referencing rules, and tender dynamics [11].  

In this environment, every launch is a signal: missteps in sequencing, list price setting, or discount architecture can quietly, and sometimes irreversibly, compress global pricing corridors. 

Future steps: 

In 2026, the winners will be the teams that run pharma pricing strategy as a corridor-management discipline — with explicit scenario planning, clear guardrails and sequenced launch choices — rather than treating pricing as a series of market-by-market negotiations. 

Do you want to keep the momentum? Explore other pricing resources from Remap Consulting: 

• What to do now? Download our Pricing Readiness checklist  

• MFN office hours (26 March 2026): Register for a practical walk-through of MFN risk scenarios, reference-market spillover and the sequencing decision tree 

References:

1. NHS England. NHS commercial framework for new medicines. Available at: https://www.england.nhs.uk/medicines-2/medicines-value-and-access/nhs-commercial-framework-for-new-medicines/ 
2. Italian Medicines Agency (AIFA). Monitoring Registers. Available at: https://www.aifa.gov.it/en/registri-farmaci-sottoposti-a-monitoraggio 
3. UK Department of Health and Social Care (GOV.UK). The 2024 voluntary scheme for branded medicines pricing, access and growth: payment percentage for 2026. Available at: https://www.gov.uk/government/publications/the-2024-voluntary-scheme-for-branded-medicines-pricing-access-and-growth-payment-percentage-for-2026/the-2024-voluntary-scheme-for-branded-medicines-pricing-access-and-growth-payment-percentage-for-2026 
4. European Commission. A pharmaceutical strategy for Europe. Available at: https://health.ec.europa.eu/medicinal-products/pharmaceutical-strategy-europe_en (see also: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52020DC0761) 
5. The White House. The Great Healthcare Plan. Available at: https://www.whitehouse.gov/greathealthcare/ 
6. Association of the British Pharmaceutical Industry (ABPI). VPAG payment rate for newer medicines will be 14.5% in 2026. Available at: https://www.abpi.org.uk/media/news/2025/december/vpag-payment-rate-for-newer-medicines-will-be-145-in-2026/ 
7. GKV-Spitzenverband. Medizinforschungsgesetz führt Geheimpreise ein. Available at: https://geschaeftsbericht.gkv-spitzenverband.de/versorgungsthemen/arzneimittel/medizinforschungsgesetz/ 
8. Deutscher Bundestag. Bundesregierung verteidigt vertrauliche Erstattungsbeträge (hib). Available at: https://www.bundestag.de/presse/hib/kurzmeldungen-1013134 
9. Patented Medicine Prices Review Board (PMPRB), Government of Canada. PMPRB releases new Guidelines to monitor and review drug prices. Available at: https://www.canada.ca/en/patented-medicine-prices-review/news/2025/06/pmprb-releases-new-guidelines-to-monitor-and-review-drug-prices.html 
10. EFPIA Japan and industry partners. Joint Statement on Need for FY2026 NHI Drug Pricing and Cost-Effectiveness Assessment System Reform. Available at: https://www.efpia.jp/link/2025-12-16_Joint_Statement_on_FY2026_Drug_Pricing_Reform_and_Cost-Effectiveness_Assessment_System_Reform_%28E%29_FINAL_Rev1.pdf 
11. Saudi Food and Drug Authority (SFDA). Verification and Abridged Pathways Guide. Available at: https://www.sfda.gov.sa/en/regulations/4870348.gov.sa/en/regulations/4870348