| Lilly's contract leaves Zepbound and Mounjaro out of the Medicaid discount. |
| LEAD ESSAY / 4 MIN / 4 DOCUMENTS / STORY FILE MFN-DEALS |
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| How do you judge a deal when you can't read it? |
| I spent this week trying to. On September 19, Public Citizen, a consumer watchdog, released the contracts behind two of the White House drug price deals. Getting them took a lawsuit under the Freedom of Information Act. That's a court fight, in plain English, to make an agency hand over its records. Two contracts came back, Pfizer's and Eli Lilly's, as about 120 pages, and much of it is blacked out. |
| Here's what you were told a year ago. Pfizer signed first, on September 30, 2025, and the White House announced it as a final deal. But the paper signed that day was a letter of agreement, which is a promise to keep talking. Neither side, its own text says, was bound to sign a final deal. Check the dates with me. Only on February 23, 2026, did the binding contract arrive, nearly five months after the ceremony... |
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Section 12.2 of the Pfizer contract |
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| Let me walk you through what the open parts say. Section 12.2 holds the government's side of the bargain. There, HHS gives Pfizer what the text calls an unmistakable promise to take each regulatory and administrative step the deal needs. And Pfizer's own exit terms? Page 21 says the company may terminate immediately under certain conditions, and I can't tell you what they are. They're redacted. |
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| "We had to get their prices up in order to get our prices down." |
| DONALD TRUMP, VIA BLOOMBERG |
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| Read that quote twice, because the contract puts it into practice. The drugmaker agreed to share part of the extra money it collects when foreign governments pay more, Bloomberg reported. That clause covers drugs already on sale, from January 1, 2026, through January 20, 2029. So prices abroad go up, and HHS takes a cut. We don't get the rate or the list of drugs. Where does the money go? According to the contract, it will lower costs for patients and taxpayers. But it gives no detail on how... |
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$1.7 billion outside Lilly's discount |
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| Now look at Lilly, whose contract has a gap of its own in one definition. GLP-1 is the drug class behind the new diabetes and weight-loss shots. Lilly defines a covered product in a way that leaves out Zepbound and Mounjaro, its two top sellers. In plain English, those two drugs don't get the Medicaid discount the deal promises for the rest. |
| Thomas Hwang, a Harvard Medical School researcher, ran the numbers for Public Citizen. Leaving out Lilly's pair could cost the Medicaid pilot up to $0.3 billion in year one. Novo Nordisk's Wegovy and Ozempic may get the same treatment. And if they do, the loss runs from $1 billion to $1.7 billion. Those figures equal 12% to 20% of the savings he first projected. |
| FILED / PFIZER AND LILLY MFN CONTRACTS |
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| Inside are HHS contracts with Pfizer and Lilly signed February 23, 2026, plus earlier letters and Commerce Department tariff letters. Key terms are redacted, including which drugs are covered and how the price is set. Under Section 13, HHS treats Pfizer's terms as exempt from public records law. |
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| One more Lilly clause caught my eye. Its terms let the company stop supplying a drug to a country, tell Washington, and have that country's price dropped from the math. This model uses the lowest price abroad as the benchmark for yours. So when Lilly stops selling in a cheap market, your benchmark goes up... |
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| Pfizer's contract ends on January 20, 2029, the last day of this administration. Lilly's end date is redacted. Both companies collected gains I can show you today. Signers avoid the 100% tariffs the White House threatened on patented medicines. Eliquis, a blood thinner Pfizer sells with Bristol Myers Squibb, got a lower list price during the talks. But Pfizer's revenue on it in America rose 25% in the second quarter from a year earlier, Public Citizen found. |
| You can read the Pfizer contract yourself, or what's left of it. I'd start with Section 13, the confidentiality clause. HHS agrees to treat the terms as exempt from public records law. Each request, the text says, triggers a written warning to Pfizer. |
| So here's where you come in. Forty states and Puerto Rico have signed up for the Medicaid program built on these deals. Remaining applicants have until September 30. And states are signing on to prices they can't see. A Lilly press release said its deal carries no pricing duty in the commercial market, where most working families buy coverage. Premiums come out of your paycheck. Medicaid runs on your taxes. And the one document that says what you get for it came back with the numbers blacked out. |
