"Faced with pressure from the Trump administration on the pharmaceutical industry, we must anticipate a surge in drug prices."

For several months, the Trump administration has intensified pressure on the pharmaceutical industry by announcing unprecedented measures, such as the introduction of tariffs on certain pharmaceutical products and a new framework for negotiating drug prices in the United States. The reasons for this policy are well known and date back several decades. Healthcare spending in the United States is particularly high: it represents 17.6% of gross domestic product, compared to an average of 10.4% in Europe. It also weighs heavily on American household budgets.

Controlling healthcare costs is a central and recurring issue in election campaigns, shared by both major political parties. In 2016, Hillary Clinton denounced the excessive prices of certain HIV treatments. In 2020, Joe Biden introduced for the first time federal negotiations on the price of certain expensive drugs between Medicare (retiree health insurance) and pharmaceutical companies.

Donald Trump had already attempted to implement the "most-favored-nation clause" as early as 2018. This measure, recently put back on the agenda, would align the price of American drugs with the lowest prices in other developed countries, particularly in Europe.

However, this clause raises a key question: what reference price should be used in international comparisons? Indeed, there are three different prices for the same drug: the net price, actually negotiated between the laboratory and the payer; the face value, officially published by the health authorities; and the pharmacy price, paid in pharmacies by patients.

There are notable differences between these three prices. The net price is equal to the face price, less any commercial discounts negotiated between the manufacturer and the payer. The pharmacy price is the face price plus the distribution channel's remuneration. The net price, set in each country, remains covered by trade secrets, which allows laboratories to adapt their commercial strategy. Laboratories adapt the amount of discounts granted to each country by taking into account factors such as the severity of the disease, the number of patients, or their ability to gain market share.

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