Will Workers’ Comp Benefit from ‘Most-Favored-Nation’ Drug Pricing?

Earlier this month, President Trump teased a “big announcement” was coming, touting it as “one of the most important … made in many years about a certain subject.”

The “big reveal” came May 12 when he signed executive order “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients.” His goal? To ensure Americans receive the lowest prices for prescription medications as offered in other countries.

It’s no secret healthcare systems in several other high-income countries are paying significantly less than the U.S. for brand-name medications. Drug manufacturers argue that high research and development costs in the U.S. and first-line access to cutting edge medications for Americans are reasons for the disparity. They additionally cite other countries have negotiation processes in place to determine pricing, making their market structure different and resulting in lower prices.

The president’s executive order notes the U.S. already provides “generous public subsidies for research and development primarily through the National Institutes of Health …” It further states that “drug manufacturers, rather than seeking to equalize evident price discrimination, agree to other countries’ demand for low prices, and simultaneously fight against the ability for public and private payers in the United States to negotiate the best prices for patients.”

Comparing Costs

So how big is the gap in drug prices and what impact could the executive order have on workers’ comp costs? Let’s compare pricing of three drugs identified in Enlyte’s recent Drug Trends Report as large cost drivers in the U.S. workers’ comp system.

Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a radiopharmaceutical treatment primarily used to treat prostate cancer. U.S. costs for the six-dose course ranges from $255,000 to $300,000. According to Bookimed, a medical tourism company, here’s what other countries’ payers spend on the same treatment dose:

• Mexico: $30,000 to $50,000
• Germany: $60,000 to $130,000
• Canada: $120,000 to $180,000
• United Kingdom: $94,500 to $118,840
• Turkey: $10,000 to $30,000

Pluvicto shows a wide disparity of cost depending on where the treatment is administered. However, payers in all countries listed are paying significantly less than those in the United States.

Gattex (teduglutide) is used to treat short bowel syndrome (SDS). The annual cost in the U.S. averages $295,000 compared to:

• Europe: $200,000 to $250,000
• Argentina: ~ $300,000
• Canada: ~ $240,000.

In this instance, price differences are not as significant from country to country or region to region.

Stelara (ustekinumab) is used to treat a variety of autoimmune disorders. A Peterson-KFF Health System Tracker report notes the following prices for a 30-day supply of Stelara by country.

• United States list price: $26,500 (net price averages $13,860)
• Canada: $3,353
• United Kingdom: $2,714
• Germany: $5,158
• Japan: $2,092
• Switzerland: $3,734
• Australia: $2,624

It is interesting to note the Medicare negotiated price for Stelara beginning in January 2026, will be $4,490. This is much lower thanks to the Inflation Reduction Act of 2022, but the U.S. will still be paying more than what other counties are currently paying other than Germany.

According to the Novartis 2024 Annual Report, Pluvicto generated $1.15 billion in sales in the U.S. and $235 million in the rest of the world. Cognitive Market Research notes in their teduglutide (Gattex) market report for 2025 that the global market is $870 million, with North America representing 29% of the market share. Stelara posted revenue of $1.69 billion in the U.S. in 2024, and $650 million internationally, according to Johnson and Johnson’s 2024 full year report.

Given the revenue imbalances it can be difficult to see how meaningful price reductions could occur in the U.S. It seems more likely other countries will experience increases in costs to match the net prices in the U.S. It is important to note that Stelara came off patent in most countries in 2024 and faced competition for biosimilars and generics. Stelara should come off patent in the U.S. this year.

Will The Executive Order Impact Comp?

Workers’ comp primarily uses generic drugs to treat injured employees. That said, these high-cost specialty drugs represent a very small volume percentage but have an outsized impact on total drug costs. If the executive order is successful in reducing costs for the small handful of branded drugs used in workers’ comp, payers reimbursing for those drugs would benefit. However, before any price reductions are realized, there are several hurdles to overcome.

The executive order requires rulemaking to impose, implement and enforce most-favored-nation pricing (placing U.S. drug prices to the lowest level paid by comparable countries). A similar executive order initiated during President Trump’s first term was invalidated by the courts on procedural grounds. The rulemaking process takes time and can be derailed by special interests, Congress or litigation from various stakeholders.

The drug manufacturers are a powerful lobbying group in Congress. According to Open Secrets, a nonprofit organization that tracks and publishes data on campaign finance and lobbying, the pharmaceutical manufacturers and their trade association spent over $151 million lobbying Congress in 2024. Open Secrets also notes pharmaceutical and health products political action committees contributed over $16 million to political candidates in the 2023-2024 cycle, fairly evenly split between Democrats and Republicans, with Republicans holding a $1.7 million edge.

The bottom line is any relief that may come due to this latest executive order will be long in coming, if it comes at all. The impact on workers’ compensation will be measurable, but likely not significant. Drug pricing and policy at the federal level is complex and the rulemaking process required by the order may not have the desired effect. Lasting change to price setting at the manufacturing level will ultimately require Congressional action, something that has been lacking for many years on this issue.

The best solution available today for workers’ compensation in various states is allowing employers to direct care to managed pharmacy networks where better pricing can be negotiated, clinical support can help suggest lower cost alternatives to some of the higher priced drugs, and utilization can be properly managed to ensure an injured employee is receiving the right drug, at the right time, for the right reason. Nearly every other commercial and government health plan requires the use of a managed pharmacy network to control costs. While not as provocative or jarring as an executive order, managed pharmacy care networks are a tried and reliable method for managing drug spending.

Allen is vice president of government affairs for Enlyte’s Pharmacy Solutions Team. He’s a policy expert for workers’ comp and insurance issues across the country.