最惠国对美国卫生与公众服务部新闻稿的思考

Akash Tewari * | Equity Analyst1 (212) 284-3416 | atewari@jefferies.comAmy Li, PharmD * | Equity Analyst+1 (332) 236-6802 | ali8@jefferies.comManoj Eradath, MBBS, Ph.D. * | EquityAssociate+1 (202) 707-6443 | meradath@jefferies.comPhoebe Tan * | Equity Associate(212) 778-8356 | ptan1@jefferies.comZaki Molvi, PhD * | Equity Associate+1 (212) 708-2726 | zmolvi@jefferies.comAnastasia Parafestas * | Equity Associate+1 (212) 336-6648 | aparafestas@jefferies.comKatherine Wang * | Equity Associate+1 (212) 778-8985 | kwang4@jefferies.com 2BiotechnologyEquity ResearchMay 20, 2025 2) We estimated the Top 50 Medicare Part B & Part D drugs by spend in '25 (including exclusions)- we gathered the Top 50 Part B & D Drugs using2025 cons revs and adjusted them for our est Medicare exposure. Note that we included vaccines, oral medication, and previous EUA products, whilemaintaining exclusions from 2020 MFN model on radiopharma & IVIG given they are often on the shortage list.Of this list, 31 drugs were from co'sin our coverage (eg, REGN, BMY, LLY, PFE, and MRK)3) We gathered the lowest ex-US price for the 31 drugs in our coverage that could be on the Top 50 Medicare Part B & D '25 list- Notably, thelowest international reference price for these 31 drugs in our coverage ranges from0~97% lower vs current US net price.Overall, here are a few early takeaways -1) We continue to flagmid cap biotech's like MDGL, EXEL, ALKS, JAZZ, BMRN, ARGX are relatively better positioned for MFNbecause they eitherhave de minimis ex-US revs, and/or low Medicare exposure, or a relatively low delta between US vs ex-US pricing. That said, co's like MDGL wouldstill need to think about their ex-US strategy (planned EU launch this year)2) We noticed the Netherlands, Norway, Canada, Australia, and Japan tend to be the countries with the lowest reference price...it's possible thatcompanies could try to mitigate MFN impact by pulling out of these countries or increasing price.= = We looked at the originally proposed 2020 MFN model & reference country criteria = =As a reminder, during President Trump’s first term, CMS introduced the Most Favored Nation Model as part of an effort to reduce Medicare Part Bdrug spending - the original 2020 model laid out a framework around implementation.We followed this method to reidentify the countries and lowest drug prices assuming similar criteria - the previous model looked at the lowest drugprices (adjusted for purchasing power) in OECD countries that were at least 60% percent of the US GDP per capita.Based on guidance from the model, we applied a GDP adjustment in order to compare international drug prices fairly to account for each country’seconomic capacity. Our adjustment is calculated by dividing a non-U.S. OECD country’s GDP per capita by the U.S. GDP per capita on a purchasingpower parity basis, which allows us to adjust country-level prices to reflect relative purchasing power. We'll note that the HHS PR doesn't specifywhether they'll use GDP per capita or GDP per capita on purchasing power parity basis - we'll note that the 202 MFN used GDP per capita on purchasingpower parity basis (which is what we're using here).Additionally, we capped the GDP adjustment at 1.0, given CMS guidance, so it can only lower foreign prices and not raise them. This ensures thatcountries with higher GDP per capita than the U.S. do not receive additional discounts. We then extended the GDP adjustment through 2040 to forecastfuture GDP by applying the average annual GDP growth rate over the past 10 years for each country.As a result, we identified 25 OECD countries thatmay be used for MFN reference pricing. These countries are Luxembourg, Ireland, Norway, Switzerland, Netherlands, Iceland, Denmark, Australia,Austria, Germany, Belgium, Sweden, Canada, Finland, France, United Kingdom, Italy, Israel, Slovenia, New Zealand, Spain, Czechia, South Korea,Lithuania, and Japan.Please see important disclosure information on pages 10 - 15 of this report.This report is intended for Jefferies clients only. Unauthorized distribution is prohibited. 3 .Source: JEF Analysis, CIA, World Bank GroupAdditionally, we'll highlight that based on the 2020 model, the MFN Price would have been phased-in over the first 4 years of the 7-year model, phasingin 25% per year for years 1-3, and would have been 100 percent of the MFN Price for years 4-7. For example, for the first year, the phase-in calculationwould use 75 percent of the US average sales price (or post discount price for part D drugs) and 25 percent of the MFN Price. In years 4-7, the MFNPrice would be fully phased-in. However, CMS would have accelerated the blending formula for a drug in years 1-4, if U.S. prices rose faster thaninflation and the MFN Price.= = We also collated the Medicare Exposure within our coverage + estimated the Top 50 Part B/D Drugs by spend in 2025 = =As a reminder, in the original 2020 MFN model, 50 Medicare Part B Top spend drugs were included based on the annual Medicar