# Healthcare Policy - Drug Pricing, IRA & Managed Care - Week of June 1, 2026: Half of Round 1 Manufacturers Already Cut WAC; ABBV to MFP

> Drug pricing and IRA newsletter for the week of May 25 to June 1, 2026. Five of the ten Round 1 manufacturers have already cut list price, with AbbVie's Imbruvica taken all the way down to MFP, the first concrete sign the IRA bleeds into commercial gross-to-net.


## Healthcare Policy: Drug Pricing, IRA & Managed Care

### Week of May 25 – June 1, 2026: Half of Round 1 Manufacturers Already Cut WAC; ABBV to MFP

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## TL;DR

- **Five of the ten Round 1 manufacturers have already lowered list price**, with **AbbVie's Imbruvica taken all the way down to MFP**, the first concrete sign that the IRA bleeds into commercial gross-to-net, not just Medicare.
- **Forty drugs are now on the negotiation list and the 2028 cohort includes Part B for the first time**, confirmed by a former HHS/CMS general counsel, who is still calling Round 1 P&L impact "too soon to tell" at 5.5 months in.
- **A quiet week.** Three episodes touched IRA at all out of ~500 scanned. No new GLP-1 (NVO/LLY) tape, no Stelara biosimilar update, no EPIC Act movement. If you need GLP-1 or biosimilar signal this week, the podcast tape is dry.

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## What's New

**1. ABBV took Imbruvica's WAC to MFP, and PBMs will follow it down.** Stephen Miller, VP of Pharmacy Services at 340B Health and the most operator-y voice of the week, said on the May 27 episode of *340B Insight* that **"half of the manufacturers for the 2026 drugs, so 5 of the 10, lowered their WAC or wholesale acquisition cost price significantly. Some all the way down to MFP as I talked about the example with AbbVie's [Im]bruvica"** ([340B Insight, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhPcS0sXItRIyFucLMMR0C3TdJ6QsVG2zNLB5VcRc81dPgUKnOha6HHDr7Q7-2Bjdnt8f1gDTIybtho4JNe5vIH1rdRO1wGyjCePyzT94jyAVAg-3D-3DFTw2_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxMJNSrcKxGNzmB-2FKm1U4-2B1pt75a779bgkOy1STjVvxlpTucWg1VWl8ToRCcNbE69c-2F0Hl292O0U4iSy-2FCgMzbkipSwLNqbvKQMpLprdwUlY-2FBVAGzeunI66vRtcRrT5zZg-3D-3D)). His non-obvious read-through: **"Insurance, PBMs are going to max the reimbursement down to that rate as well"**, i.e. the IRA price effectively leaks into commercial reimbursement once WAC moves. This is the tradeable insight of the week; check whether MRK (Januvia), BMY/PFE (Eliquis), AZN (Farxiga), and LLY (Jardiance) have made comparable WAC moves.

**2. Round 2 manufacturers are taking modest 2026 price.** Same episode: Round 2 list prices have risen **"0% to 6%, with most in the 2-4% range"** for 2026 ([340B Insight, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhPcS0sXItRIyFucLMMR0C3TdJ6QsVG2zNLB5VcRc81dPgUKnOha6HHDr7Q7-2Bjdnt8f1gDTIybtho4JNe5vIH1rdRO1wGyjCePyzT94jyAVAg-3D-3DwPvP_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxJxHSCZ75HX-2FdWGncU7O1ky5DpVUme52jH2lP7FtcAwAlv5LpUIwTKZZqDp3rZd5XXQMiAO-2BHaO8YGCtsCSgnjCpQ87nIbDxU571obQNBlvSlWSzeXBE4J2m-2B4IINIhK0w-3D-3D)), well below the historical 6–8% playbook, consistent with manufacturers managing optics into negotiation. Miller also flagged that **4 of the 10 Round 1 drugs will drop off the IRA list at the start of 2027** per CMS guidance, which begins to set up the LOE/biosimilar cliff narrative.

**3. Forty drugs on the list; Part B in the 2028 cohort.** Tom Barker (Foley Hoag partner, former Acting GC of HHS, former CLO of CMS) on *DC EKG* with Joe Grogan (former Trump White House DPC director): **"There are now 40 drugs that have been selected for negotiation... this year, for the first time, Part B drugs are subject to negotiation"** ([DC EKG, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiCiONP4hefrJW-2Fjx-2BUpnKH9wNv2LgZ8iYlftTRwd08axEKvuEPa0eWcOwGGqsKBytwwvnJKfK3AJ6iQChTcYxCKyi91sPX3w0QP2MpLlKhmg-3D-3DGdJ1_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxFv4pPbkw-2BgBPUrjFgEhVBy0jKGkXaUQ4UaW5SF-2F4xCtkIGzC7-2Bkb5RtJuS3CptABFxZUKujK9ISCHzzl3s-2BgB7f30xtFqHsbi-2FhrDj-2FVRUwpqDtqHiSjuXrzZ-2FleHHxyw-3D-3D)). The Part B inclusion is the structural change that opens up physician-administered oncology and immunology franchises, most obviously Keytruda's IV formulation for MRK in 2028.

**4. MFN models are coming, but still undefined.** Barker: **"the B and D models are going to be mandatory, and those are going to take effect at some point in the next year or so"** ([DC EKG, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiCiONP4hefrJW-2Fjx-2BUpnKH9wNv2LgZ8iYlftTRwd08axEKvuEPa0eWcOwGGqsKBytwwvnJKfK3AJ6iQChTcYxCKyi91sPX3w0QP2MpLlKhmg-3D-3DyAYq_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxKMxATIcarjVzSf8Svx1QmbnUg7-2FfV-2BdfSinz50H1DuuiLd0NUSD-2Fn5djcHAYwRO9TrPn9IMYs2ZmcKFkrUn9y3k5FI5XFyerZ1GCA4dgi454DxBxZ0pOrCzs2eUqx8O7Q-3D-3D)), referring to the "Globe" and "Guard" Part B demonstrations and the "Generous" Part D model. Richard Pops, CEO of Alkermes, on *The BioCentury Show*: **"We don't know what MFN actually is... based on the 17 bespoke deals that have been done, is there a central tendency among them or is each of them actually a bespoke deal?"** ([The BioCentury Show, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOjJXhvpYveY16Y92Y6YhjDKiNIF-2F6WxA36RGbxL9WMR0pGBV3NDA1wi3V83t2z0pppLMQ64-2B-2BUUEhVnaGD9LBpa0NMH-2F5yQzVzZnrGGkUraGQ-3D-3DeNYw_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxBScZ9D53OsWJM448DiW0B54CybdojatL9xTDYqEow6svEu0yHjgn6gT1xooaL-2Bms9a3N5Vvbsek-2FzraLZitln-2F9OXlah3ZdE5uTO65sC9xIAUA-2FgWynrnKSj6JwGT-2BKFw-3D-3D)). Translation: MFN remains a fat-tail risk the market cannot price.

**5. Part D premium cap is the unspoken 2027 risk.** Barker flagged that Part D **"premiums are artificially capped... When that cap comes off, there is the potential for a huge increase in Part D premiums"** ([DC EKG, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiCiONP4hefrJW-2Fjx-2BUpnKH9wNv2LgZ8iYlftTRwd08axEKvuEPa0eWcOwGGqsKBytwwvnJKfK3AJ6iQChTcYxCKyi91sPX3w0QP2MpLlKhmg-3D-3DpldW_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxC-2F3of3RFr8UvXIrZICMHvIYPnSyfyshwFr7D5QNC47QSOH2khsbIgxyf7E7pQwPUKtfAtEHStxhJvHLgASygShNpLgQ5SvOLwHLpzFU5ii2-2BSC3adwc1rlrWufZgqH88g-3D-3D)), a sleeper read-through for the MA-PD plan economics at UNH, CVS (Aetna), CI, and HUM.

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## The Debate

**Bull (manageable modeled headwind).** Round 1 is 5.5 months in and Barker, an actual former CMS general counsel, is still saying **"it's too soon to tell"** ([DC EKG, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiCiONP4hefrJW-2Fjx-2BUpnKH9wNv2LgZ8iYlftTRwd08axEKvuEPa0eWcOwGGqsKBytwwvnJKfK3AJ6iQChTcYxCKyi91sPX3w0QP2MpLlKhmg-3D-3D9Lys_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxCzwCk20KGhVqR0c02zJfONbIRnYETFq11CsVRgFBlthAlbMpViWa62Lcq5aOOj8mbATLOnOWKRnp9DwlrO1Ezbgvwt91a9UJoooxWlXoeIPrqo2d1t2hi9hbbHwbrDpZQ-3D-3D)). Round 2 manufacturers are taking single-digit list price into negotiation, four of the Round 1 drugs roll off the list in 2027, and the actual MFP cuts are already in every sell-side model. The story is well-known and largely priced.

**Bear (structural US margin compression with a small-mol R&D pullback).** The tape from operators argues the cost is bigger than priced in three directions. **One**, commercial gross-to-net is now coupled to MFP: once WAC drops, PBMs reset reimbursement, so the IRA is not a Medicare-only headwind. **Two**, the pill penalty is rewriting the R&D mix; Pops' framing is the clearest articulation of the capital-allocation math: **"Post IRA, nine years of exclusivity versus 13 years of exclusivity. If you draw a curve of the revenue profile of a drug over its life with the ramp and the plateau and you clip off the back four years, that's half of the revenues. So from a purely economic perspective, you should develop biologics instead of small molecules"** ([The BioCentury Show, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOjJXhvpYveY16Y92Y6YhjDKiNIF-2F6WxA36RGbxL9WMR0pGBV3NDA1wi3V83t2z0pppLMQ64-2B-2BUUEhVnaGD9LBpa0NMH-2F5yQzVzZnrGGkUraGQ-3D-3D139H_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxFeH-2F7Ckfgq-2BjgO90C06fb9X0-2FnITiciMdP-2B2a3JZq3HYWltm1zcF-2B9ix8I4NPLJ7xsQnUXGG9ROCBcvamqwV7WlKPsmHY-2Fixl2XWl0wcLs2yPXomc2GvPYRXhMsiY-2Feqw-3D-3D)). **Three**, mandatory MFN Part B and Part D models on a 12-month horizon, plus Part B negotiation in the 2028 cohort, layer two more leg-downs onto US franchise NPVs. Bear take: today's MFP is a floor, not a ceiling.

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## Stocks in Play

| Ticker | Bull | Bear | Next Catalyst / Watch |
| --- | --- | --- | --- |
| **ABBV** | Imbruvica is shrinking anyway under Calquence/Brukinsa competition; WAC-to-MFP is incremental, not fatal. | First named-drug example of WAC fully cut to MFP; commercial gross-to-net on Imbruvica re-rates lower. Linzess in Round 2 (2027). | Whether ABBV signals similar repricing on Venclexta or Linzess; Linzess MFP publication late 2026. |
| **MRK** | Subcutaneous Keytruda extends franchise exclusivity past 2028 if uptake is strong. | Part B is in the 2028 cohort. IV Keytruda is the prototype Part B IRA target. Januvia/Janumet already on Round 1. | 2028 selected drug list (Part B); SC Keytruda share trajectory. |
| **BMY / PFE** | Eliquis MFP is already in numbers; Pomalyst and Ibrance are smaller. | Eliquis MFP live 1/1/26; if WAC follows Imbruvica down, commercial reimbursement compresses too. | PFE/BMY WAC actions on Eliquis (analog to ABBV/Imbruvica). |
| **LLY** | Jardiance is co-developed with BI; LLY's exposure is partial; GLP-1 franchise is the actual story. | Jardiance on Round 1; tirzepatide/Mounjaro/Zepbound is the obvious Round 3 candidate when it crosses the 7-year small-molecule clock. | Round 3 (2029) selected list; pill penalty messaging on orforglipron. |
| **NVO** | NovoLog MFP already digested; semaglutide negotiation is years out. | If Ozempic/Wegovy is on the Round 2 list (2028 effective), the franchise NPV compresses materially. | Confirmation of semaglutide on the 2028 list. |
| **AZN** | Farxiga is co-promoted; Tagrisso has biologic-adjacent durability. | Farxiga MFP live 1/1/26; Calquence is a Round 2 candidate. | AZN WAC action on Farxiga. |
| **TEVA** | Direct beneficiary of Round 1 LOE rolloffs in 2027 via biosimilars/generics. | Austedo is a 2028 Round 2 selection candidate. | 2028 list confirmation for Austedo. |

*No episode this week named a per-franchise revenue-at-risk number. These are watch items, not fresh estimates.*

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## Read-Throughs

- **PBMs / managed care (CVS, CI, UNH, HUM).** Miller's claim that PBMs will "max the reimbursement down to that [MFP] rate" ([340B Insight, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOhPcS0sXItRIyFucLMMR0C3TdJ6QsVG2zNLB5VcRc81dPgUKnOha6HHDr7Q7-2Bjdnt8f1gDTIybtho4JNe5vIH1rdRO1wGyjCePyzT94jyAVAg-3D-3DhEEI_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxKK6W9u7D6dAuNIE6JlVGJ3JYuGaRZzEB-2F7PTWhHrSTpbVn-2BaQBAk5HE7OKm6QRDGJugEyEvACOeX9eL0xILP36iA55k7UFVwxevGmCFUFNQ8MIGwPZbP6JOL56xfFrVXg-3D-3D)) is a net-neutral-to-positive read for Caremark/ESI/Optum Rx (lower acquisition cost), but Part D plan economics get more complicated when the premium cap rolls off. Watch 2027 MA-PD bids.
- **Hospitals / 340B (HCA, THC, CYH).** The 340B ceiling-price lag is **two quarters**: Jan 1 WAC cuts hit hospital 340B savings July 1. Litigation update from Barker: HRSA rebate model struck down in Maine (Dec 2025 proposal); new RFP comment period closed; state-law preemption wins for manufacturers in North Dakota and the 4th Circuit on West Virginia ([DC EKG, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOiCiONP4hefrJW-2Fjx-2BUpnKH9wNv2LgZ8iYlftTRwd08axEKvuEPa0eWcOwGGqsKBytwwvnJKfK3AJ6iQChTcYxCKyi91sPX3w0QP2MpLlKhmg-3D-3Dv7ZE_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxAWFl8BNvSKXPhH6yfk5HCuSeP1LC7OKx0QN41CjwrfyekvIKdrlO-2BX1Ab9JNBp7p2z7pBM1Xt5nuDXFMcdSAUJjDo-2BYLGlBHCzd-2BAUN-2B4Vhw871qQfyb871-2BI36MY6Fvg-3D-3D)). 340B is now an **"$80 billion program"**, larger than every drug program except Part D.
- **Small-mol biotech (ALKS, VRTX, INCY, mid-cap pipelines).** Pops disclosed that the original Part D catastrophic-phase manufacturer liability change **"would have taken us from a 0% liability to a 20% tax on our revenues. It would have taken us from being profitable to being not profitable"** ([The BioCentury Show, May 2026](http://url7324.matterfact.com/ls/click?upn=u001.idHmPrr2Geh7KYLAsTy7NkrIVb-2FgA4pmf2rMXQwGcOjJXhvpYveY16Y92Y6YhjDKiNIF-2F6WxA36RGbxL9WMR0pGBV3NDA1wi3V83t2z0pppLMQ64-2B-2BUUEhVnaGD9LBpa0NMH-2F5yQzVzZnrGGkUraGQ-3D-3DAnyx_7mLGwmUci-2BLaXswv9WX1yTgqn3Wad-2FotHhzHgSNAZbVCEsgTDWyLofT7X2oe-2BwLWnxfz9Wdm9629ZvLjVNIoxC9RybHzOBI-2FzLn6KveG71PaaSdDyKt8xGGnexzsXp5RQV9Vg6oeqhwO4Vrj-2B45KTbN9dxCQUdjBTBV16Gf3gsceUIp8hSr6pA7wIMqX6dRpHYpSKi65PPktuB0WQCWQMA-3D-3D)). Mid-cap small-molecule names with concentrated Part D exposure remain the most idiosyncratic risk under the structural IRA architecture.
- **Ex-US / European launch strategy.** Pops surfaced a subtle MFN exposure for companies that **don't** sell in Europe: if a competitor does at a lower price, rebate clawbacks could still apply. Not modelable yet but worth tagging.

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## What Changed vs Last Week

This is the inaugural run of this newsletter, no prior week to compare against. Going forward, we will flag delta-vs-prior-week here. If a future week is quiet, we'll say so plainly.

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