A new peer-reviewed study published in Health Affairs Scholar compares how the United States values the cost of health interventions — measured in cost per quality-adjusted life year (QALY) — against countries named as Most Favored Nations under a 2025 presidential executive order on prescription drug pricing. The findings matter for anyone taking GLP-1 medications like Ozempic, Wegovy, Mounjaro, or Zepbound, which remain among the most expensive drugs on the US market.
What the Study Examined
Researchers analyzed 6,876 cost-per-QALY studies to understand how the US sets its cost-effectiveness thresholds — the benchmarks used to decide whether a drug or treatment delivers good value for the money spent. They then compared those US thresholds to the ones used by countries designated as Most Favored Nations (MFNs) under the 2025 executive order on prescription drug pricing.
Cost-effectiveness thresholds are a key tool in drug pricing negotiations. Countries that apply lower thresholds — meaning they demand more health benefit per dollar spent — tend to pay less for medications. Understanding how US thresholds compare to those in MFN countries helps explain why Americans often pay significantly more for the same drugs.
Why This Matters for GLP-1 Users
GLP-1 receptor agonists such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are frequently cited in discussions about US drug pricing because of their high list prices and surging demand. The 2025 executive order specifically references Most Favored Nation pricing as a mechanism to bring US drug costs closer to what peer nations pay.
If US policymakers adopt pricing frameworks more aligned with MFN thresholds, manufacturers could face pressure to lower prices for high-cost medications — a category that prominently includes GLP-1 drugs. Conversely, stricter cost-effectiveness standards could affect which GLP-1 indications insurers choose to cover.
The 2025 executive order on Most Favored Nation drug pricing is designed to benchmark US drug costs against what other countries pay — and a new peer-reviewed analysis is now formally comparing the cost-effectiveness thresholds that underpin those price differences.
The Bigger Policy Picture
The Most Favored Nation executive order signed in 2025 directs attention to the gap between what the US pays for prescription drugs and what other developed nations pay. By analyzing published cost-effectiveness analyses across thousands of studies, this new research gives policymakers and insurers a data-driven foundation for understanding where US thresholds sit relative to MFN countries — and how large the gap really is.
For patients, this kind of research feeds directly into policy debates that could shape insurance coverage decisions, out-of-pocket costs, and manufacturer rebate structures for GLP-1 medications in the years ahead.
What to Watch Next
- How the 2025 executive order on MFN pricing is implemented and which drugs are prioritized
- Whether Medicare or private insurers begin applying stricter cost-effectiveness thresholds to GLP-1 coverage decisions
- Follow-up research that publishes the full comparative threshold data from all 6,876 studies reviewed
- Manufacturer responses from Novo Nordisk and Eli Lilly if MFN pricing pressure intensifies
Frequently Asked Questions
Drug pricing policy is complex and evolving quickly. If you have concerns about the cost of your GLP-1 medication or how potential policy changes might affect your access or coverage, speak with your prescriber or a pharmacist who can help you explore your current options.
- Peer-reviewed journal article, 'Cost-effectiveness thresholds used in the United States vs most favored nations,' Health Affairs Scholar, 2025.