Pharma Firms Not in Trump Drug Pricing Deals Explore Self-Negotiations Amid Medicare Pilot Risks

February 11, 2026 — Pharmaceutical companies not targeted by the Trump administration for U.S. drug pricing agreements are exploring direct negotiations with White House and CMS contacts to secure similar terms. Concerns center on Medicare pilot programs (GLOBE, GUARD) that could set prices for Medicare drugs and require rebates if U.S. prices exceed international levels. As of February 11, 16 major drugmakers, including Pfizer and Eli Lilly, had signed administration-directed price reductions. About half of PhRMA-represented companies have not received directive letters, prompting smaller and mid-sized firms to form the Midsized Biotech Alliance of America and lobby against new price-setting measures. Companies warn existing deals mostly affect U.S. Medicaid, which accounts for roughly 10% of drug spending. The broader Medicare program, covering millions of seniors, faces a most-favored-nation-style pricing framework under the pilots, potentially requiring significant price concessions for uncooperative manufacturers.