What is at stake is a pricing regime designed in Washington to loot the social systems of Europe. The result could be a continent where the rich pay more, and the poor get nothing.
The mechanism of action is the Most Favoured Nation (MFN) model. It stipulates that US Medicare cannot pay more for drugs than the lowest price in a "basket" of wealthy nations, including France, Germany, and Denmark. Despite looking like a domestic US cost-cutting measure, it is a global price floor that weaponizes Europe’s social solidarity against itself.
European healthcare systems use their collective bargaining power to negotiate lower drug prices. This is the dividend of a functional public sector that serves its citizens, which the MFN regime turns into a vice. Negotiating a lower price for a cancer drug instantly drags down the price in the US market – an economic giant, where companies make the majority of their global profits.
Europe's "Health Union" can no longer be a vague aspiration. It must become a defensive shield
To protect US margins, companies will sequence their launches and release life-saving medicines in the US first, delaying entry into Europe by months or years to avoid setting a low reference price. Small drug developers and those developing niche drugs for rare diseases may never launch in Europe at all.
When a drug is delayed in Germany to protect a US price point, it creates an even bigger void for countries who legally rely on German prices to set their own. Without a Western European benchmark, the drug cannot legally enter the market in the East. US policy thus effectively imposes a blockade on Europe's most vulnerable patients.
Europe has no choice but to respond with the same ruthlessness that is being applied against it. Our response must move beyond the fragmented national competencies that currently paralyze the continent.
Europe has no choice but to respond with the same ruthlessness that is being applied against it
First, Europe must embrace strategic opacity : its "list prices" transparency is the hook upon which the US hangs its MFN policy. Member states should shift to a confidential "net pricing" system, where the official list price remains high, satisfying US benchmarks, while the actual price paid by health systems is discounted through invisible rebates linked to GDP per capita. Confidential rebates are already a reality in the US; Europe should make use of them as well.
Second, the EU must do even more to close the gap in access to medicines at home. The answer is more Europe. By centralising procedures at the European Medicines Agency, the EU regulator, clinical trial and drug approval timelines can be cut significantly. And by creating real pathways for cross-border access to healthcare, Europe can help more patients while stimulating more innovation in the life sciences. A humane and innovative continent is also a more resilient one.
Finally, Europe must treat MFN as a trade aggression. If US policy explicitly targets European social security models to subsidize American dysfunction, then the EU must be prepared to use its market access as leverage. Europe's "Health Union" can no longer be a vague aspiration. It must become a defensive shield.
Washington is betting that Europe is too divided to protect its own social contract. It is now up to European leaders to prove that the price of their citizens' health is not set in the White House.
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