H.R. 7837 — Most Favored Patient Act of 2026

This section requires the Center for Medicare and Medicaid Innovation (CMI) to include the Most Favored Nations Pricing Model in its selection of models to test beginning January 1, 2029. As background, the CMI tests innovative payment and service delivery models under Medicare (Title XVIII) and Medicaid (Title XIX) to reduce program expenditures while preserving or enhancing quality of care. Under the model, which lasts 5 years, each specified manufacturer (i.e., a manufacturer of a covered drug without a covered agreement with the Secretary) must (1) provide access to the most-favored-nation price—defined as the second-lowest applicable net price (average price paid across package sizes/types in a reference country, adjusted for purchasing power parity differences with the U.S.) among eight reference countries (Canada, Denmark, France, Germany, Italy, Japan, Switzerland, and the United Kingdom)—for each covered drug (i.e., a specified drug sold in two or more reference countries during the year) to most-favored-nation price eligible individuals (Medicaid enrollees for dispensed drugs; Part D or Medicare Advantage-Part D enrollees for dispensed drugs; Part B enrollees, including Medicare Advantage enrollees, for furnished or administered drugs), pharmacies, mail-order services, dispensers, hospitals, physicians, and other providers/suppliers; and (2) report necessary information to the Secretary for price calculations. Specified drugs include covered outpatient drugs, Part B drugs or biologicals, and Part D drugs. The Secretary may suspend requirements for a drug until April 1, 2029, if the manufacturer is likely to enter a covered agreement by December 31, 2028 (requiring most-favored-nation pricing access, reporting, a U.S. manufacturing commitment, and congressional reporting). (Thus, the model seeks to align certain Medicare and Medicaid drug prices with lower prices in selected foreign countries.)