US market access and HEOR teams have always operated with a remarkable degree of autonomy from global functions. Anyone who’s worked across both sides knows the dynamic. US teams essentially run as their own corporate. Different payer landscape, different contracting logic, different timelines. Global often lacks the context to meaningfully intervene, and frankly, US revenue numbers tend to buy a lot of organisational independence.
This holds true even when the global function sits in the US. Same building, sometimes the same floor. Still largely separate worlds.
Yes, global pricing committees exist. But let’s be honest about what they’ve actually governed. Ex-US reference pricing. Launch sequencing to protect European corridors. The US was never in scope because it didn’t need to be. Nobody was referencing the US price downward.
MFN changes that equation.
With US reimbursement now pegged to OECD reference prices, the US is inside the reference pricing web for the first time. Any market access decision in a reference country directly affects the US top line. And any US market access strategy now shapes what manufacturers are willing to offer in other markets — leading to harder positions in reference countries, delayed launches, restructured confidential arrangements.
That feedback loop didn’t exist before.
Market access decisions can no longer be made in isolation. Existing governance structures weren’t designed for this.
So will this lead to a redistribution of power from US market access teams to global functions? Or will it render global functions obsolete entirely?