The Global Price Anchor: Why 2026 is the Year of the "Glocal" Drug Strategy

The landscape of drug pricing has shifted significantly in the first four weeks of 2026 as the walls between U.S. domestic pricing and international market access have effectively collapsed. For pharmaceutical manufacturers, there is no longer such a thing as a "local" price negotiation; every international deal is now a potential anchor for the American market.

The New Reality: Codification and the "Great Healthcare Plan"

On January 15, the White House released "The Great Healthcare Plan," a policy framework that calls on Congress to codify the administration's Most-Favored-Nation (MFN) deals into law. This plan aims to move the U.S. from voluntary negotiations toward a mandatory system that permanently ties domestic prices to the lowest levels paid by peer countries. The goal is clear: ensure that Americans pay no more than patients in other developed nations, effectively ending what the administration calls "foreign freeloading."

The momentum behind this shift is significant and accelerating:

• 16 Major Pacts: As of late January, 16 of the 17 targeted pharmaceutical manufacturers—including giants like Pfizer, Merck, AbbVie, and GSK—have entered into voluntary drug pricing agreements with the administration. These companies have traded deep discounts for a three-year suspension of national security-related tariffs, creating a temporary peace that hinges on maintaining international price parity. In exchange, companies like Merck and Pfizer are committing to investing over $150 billion in U.S. manufacturing to reduce reliance on foreign supply chains.
• The Launch of TrumpRx: The administration's direct-to-consumer platform, TrumpRx.gov, is now live and functioning as a federal "direct-buy" portal. It allows patients to purchase chronic care and specialty medications directly from manufacturers at MFN-based prices—often resulting in savings of 50% to 85% for treatments. For example, Amgen has reduced the price of Repatha from $573 to $239, and Gilead has slashed Epclusa from $24,920 to $2,425 for direct cash-paying customers.
• Expanded Negotiations: On January 27, CMS announced the selection of 15 additional drugs for the third cycle of Medicare price negotiations. For the first time, this list includes provider-administered Part B drugs (like Orencia and Cosentyx) alongside Part D blockbusters like Biktarvy and Trulicity. The inclusion of Part B drugs is a watershed moment, as these clinic-administered therapies were previously shielded from direct negotiation.

The Mandatory Pivot: GLOBE and GUARD

While 2025 was the year of "voluntary" agreements, 2026 will be the year of mandatory compliance. The administration is now moving toward structural enforcement through two new rebate models that began implementation this month:

• The GLOBE Model (Global Benchmark for Efficient Drug Pricing): This mandatory model targets high-cost Part B drugs in clinical settings—such as oncology and immunology. It modifies the Medicare inflation rebate calculation to reflect prices paid in a set of "economically comparable" countries (those with a GDP per capita at least 60% of the U.S. level). If the U.S. price exceeds the international benchmark, the manufacturer must pay the difference back to the Medicare Trust Fund. CMS estimates this will save Medicare $11.9 billion over five years.
• The GUARD Model (Guarding U.S. Medicare Against Rising Drug Costs): This mandatory pilot program for Part D drugs currently impacts roughly one-quarter of all Medicare beneficiaries. It pegs manufacturer rebates to international benchmarks, ensuring that for millions of seniors, the "lowest global price" is now the effective U.S. ceiling. While it saves the government billions, analysts warn it could increase out-of-pocket costs for some beneficiaries as manufacturers adjust their pricing strategies.

In essence, if a manufacturer agrees to a lower price in the UK or Japan to secure market access, that lower price can now be "imported" into the U.S. through GLOBE or GUARD, triggering hundreds of millions of dollars in mandatory rebates.

Why "Local" Politics is Now "Global" Strategy

The "Most Favored Nation" approach relies on the logic that the U.S. should simply outsource its drug valuation to its peers. However, this creates a dangerous "Global Price Anchor" trap. As noted in recent industry analysis, this policy uses “bad logic” by ignoring the systemic differences in how healthcare is delivered. In peer nations, low drug prices are possible because the rest of their healthcare—doctors, nurses, and hospital beds—is also cheap. In the U.S., drugs are often the only thing preventing a patient from entering an incredibly expensive hospital system. When we link U.S. prices to these international benchmarks, we are essentially ignoring the massive cost-savings that innovative medicines provide specifically to the American economy.

By linking U.S. revenue to international negotiations, the administration has inadvertently made every local health technology assessment (HTA) in Europe or APAC a "boardroom level" event in New Jersey or Basel. A concession made in a LATAM tender or an EMEA pricing review is no longer just a regional volume play; it is a global revenue risk.

For manufacturers, the strategic consequences include:

1. Launch Sequence Shifts: Companies are increasingly adopting a "wait-and-see" approach or even delaying launches in lower-priced markets to protect their U.S. benchmarks. A recent survey shows 64% of companies are likely to withdraw from or delay launches in selected EU27 countries in the short run.
2. Increased Use of "Shadow" Discounts: A surge in confidential rebates and outcomes-based agreements to maintain "list price" integrity and avoid triggering international reference pricing (IRP) cascades.
3. Heightened Stakeholder Scrutiny: Local regulators in emerging markets now have unprecedented leverage, knowing that their decisions carry global weight. In the UK, the government has already negotiated a 25% increase in net prices for innovative medicines to dodge U.S. import duties.

How Speyside Navigates the "Glocal" Gap

At Speyside, we have always maintained that while access is driven by science and economics, the politics around access is often the deciding factor. In 2026, understanding and engaging local stakeholders in APAC, LATAM, and EMEA is no longer a "nice-to-have" regional task; it is a core U.S. revenue protection strategy.

When the U.S. administration "outsources" its drug pricing to other nations, the people in those nations—the regulators, the patient groups, and the local payers—effectively become the gatekeepers of your U.S. bottom line.

We work with globally leading pharma clients to navigate these high-stakes negotiations on the ground. The localized intelligence we provide helps them build value stories that resonate with local authorities while strategically protecting their global pricing integrity. Through bridging the gap between global policy teams and local market access units, we ensure that a "win" in an international market doesn't become a "loss" back home. Whether it is through product target profile testing with payers, roundtable discussions, or simple monitoring and landscape assessment, Speyside is equipped to support our clients in navigating the increasingly complex and changing global market access environment.

If you are re-evaluating your international access strategy in light of these new MFN pressures, let’s talk.

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