Sponsor: Pfizer
See Professor Pita Barros’s presentation HERE.
Drug pricing policy in the United States is entering a new phase, and its consequences could be felt far beyond the American market.
That was the starting point for the meeting “The MFN Effect: Europe, the US and the Future of Health in Portugal”, hosted by AmCham Portugal, which brought together more than 60 representatives of the business and health sectors to discuss the implications of the Most Favored Nation (MFN) model for access to innovation, the sustainability of health systems and European and Portuguese competitiveness.
Throughout the morning, experts, industry representatives, regulators and policymakers sought to answer a central question: in a context of growing pressure on drug prices, how can Portugal guarantee access to innovation without compromising the sustainability of the NHS and its ability to attract investment and research?
MFN and its long-term effects
The opening session was given by Paulo Teixeira, Chair of AmCham Portugal’s Health & Biotechnology Committee and Country/General Manager of Pfizer Portugal, who drew attention to a dimension of particular relevance to Portugal: the impact of MFN may not be limited to a discussion about prices, but may also affect when medicines reach patients.
“The risk for Portugal is not just paying more. It is waiting longer.”
Paulo Teixeira highlighted recent trends in access to medicines approved by the EMA: although availability in Portugal has risen from 42% to 52%, the time between European authorization and availability in the country has increased from 577 to 784 days. INFARMED data also point to a process that can exceed 650 days between application and access.
In this context, he argued that time, predictability and speed of decision-making should be treated as strategic dimensions of the NHS’s performance.
The presentation by Pedro Pita Barros, Full Professor at Nova SBE, BPI | “la Caixa” Foundation Chair in Health Economics, explored the issue from an economic perspective.
A new balance for the global market
Pedro Pita Barros explained that MFN should be understood not just as an immediate change in prices in the United States, but as a potentially structural shift in the balance of the global pharmaceutical market.
Lower prices in the US could increase the pressure on other markets to accept higher prices, while companies could adapt their launch, pricing and research and development investment strategies.
One of the main unknowns lies precisely in the new balance that may emerge: which countries will pay more, which medicines may be launched later, and how will innovation be financed in the future?
The debate also highlighted a broader question: if the benefits of innovation are global, its sustainability also requires mechanisms that distribute the costs of financing research in a balanced way, taking into account the value generated, countries’ economic capacity and the needs of their populations.
Panel I – Perspectives on MFN and pharmaceutical policy
The first panel brought together Francisca Paulouro (VdA), Hélder Mota Filipe (Portuguese Pharmaceutical Society) and Nathalie Cardinal von Widder (AstraZeneca Portugal), moderated by Filipa Mota e Costa (Johnson & Johnson Innovative Medicine).
The discussion started from a reality that predates MFN itself: Europe already faces structural challenges in competitiveness, access to innovation and the sustainability of its health systems.
More than an expense: medicines as an investment
One of the panel’s central ideas was the need to look at pharmaceutical policy beyond the direct spending of the Ministry of Health.
Hélder Mota Filipe stressed that an assessment focused solely on the cost of medicines can overlook wider benefits, such as fewer hospitalizations, higher productivity and the impact on patients’ quality of life.
This perspective was linked to a more strategic view of the pharmaceutical sector as an asset for investment, research, manufacturing, skilled employment and knowledge creation in Portugal.
For Nathalie Cardinal von Widder, investment decisions depend on a predictable and competitive ecosystem, where access, pricing and funding models, protection of innovation, talent and research capacity reinforce each other.
The challenge of balancing sustainability and access
Francisca Paulouro drew attention to the limits of a policy overly focused on containing spending. Mechanisms that automatically pass on to industry the impact of any additional pressure on budgets can create perverse incentives, contributing to delays or decisions not to make products available.
As an alternative, an approach based on value, outcomes and risk-sharing gained ground in the debate, allowing funding models to take into account the benefit actually delivered by medicines.
Data to turn risk into decisions
The discussion also converged on the role of health data and outcomes-based payment models.
Portugal has a significant amount of information, but still struggles to link, analyze and use it systematically. For the participants, improving the ability to generate and use real-world patient outcome data would make it possible to better assess the value of therapies and create funding models better aligned with the results achieved.
Hélder Mota Filipe argued that outcomes-based renegotiation should no longer be the exception and should become a more structured part of funding mechanisms.
A pharmaceutical policy with an impact on competitiveness
The panel also stressed that medicines policy cannot be analyzed in isolation within health policy.
Decisions on access, pricing and funding have an impact on clinical research, industrial investment, the creation of skilled jobs, exports and Portugal’s ability to position itself in international innovation chains.
In this context, predictability took on particular importance. As was discussed, formal protection of intellectual property is not enough: delays in access and in negotiation processes can, in practice, shorten the period in which an innovation can recoup the investment made.
Panel II – MFN and the future of access to medicines: what political and institutional response?
The second panel brought different political perspectives to the discussion, with Mário Amorim Lopes (IL), Miguel Guimarães (PSD), Pedro Frazão (CHEGA) and Sofia Andrade (PS), moderated by journalist Rosa Pedroso Lima.
Despite differences in approach, the debate brought several common issues to the fore: access to innovation, sustainability, use of data, institutional capacity and preparedness for a changing international context.
MFN beyond price comparisons
Mário Amorim Lopes drew attention to the economic logic of price differentiation between markets. According to the view presented, higher prices in certain markets can help recover the high fixed costs of research and development and thereby make medicines available in markets with less ability to pay.
The issue should therefore be analyzed not only by comparing Portuguese and American prices, but also by taking into account how the global market works and the impact on overall welfare.
From cost to the value generated in health
Miguel Guimarães pointed out that MFN is not a Portuguese initiative, but it confronts Portugal with issues that are already central to the health system: access, price, innovation and sustainability.
In the view presented, it is important to move from a logic centered mainly on “how much it costs” to a broader assessment of “how much value it generates”, including funding models linked to health outcomes.
Measuring the time to the first patient
One of the most concrete proposals came from Pedro Frazão, who called for greater transparency over the entire journey between the European authorization of a medicine and its actual use by patients.
This journey includes authorization, the application for introduction, assessment, negotiation, the funding decision, availability and, finally, the moment the first patient is treated.
The proposal is to measure each of these stages and identify who is responsible for waiting times, based on a simple principle: innovation only creates value when it reaches the patient.
The debate also addressed the need for more predictable and faster access mechanisms for situations of urgent clinical need.
Data, institutional capacity and execution
Sofia Andrade highlighted the significant amount of data in the Portuguese health system, but also the challenges involved in analyzing, processing and using it.
The discussion thus revealed a cross-cutting issue: between setting objectives and delivering on them there is still considerable room for improvement. Reforms, instruments and mechanisms may formally exist, but their impact depends on the capacity to put them into practice.
Manufacturing, innovation and resilience
The panel also addressed the need to strengthen European and national manufacturing and innovation capacity, in a context of growing external dependencies.
The importance of strengthening Portugal’s and Europe’s strategic capacity was discussed, including investment in research, domestic manufacturing and mechanisms that contribute to security of supply.
In this context, the idea of a national strategic reserve of medicines was also discussed, as a tool to respond to crises or emergencies.
From debate to action: predictability, speed and value
In the open debate session, the need to look at MFN as part of a broader transformation of health policy and of the international economic context became clear.
For Portugal, three dimensions are particularly relevant: predictability, speed and quality of assessment.
As Paulo Teixeira emphasized, the country cannot control the decisions taken in Washington, but it can improve the quality and speed of the decisions taken in Lisbon.
The reduction in the average approval time for clinical trials in Portugal, from 71 days in 2023 to 32 days in 2025, shows that it is possible to improve processes without compromising rigor. The question now is how to apply that capacity to other stages of the path to accessing innovation.
“Speed does not mean less rigor. The time a decision takes is itself part of the value or the cost of that decision.”
Portugal facing a new transatlantic reality
Paulo Teixeira also showed that MFN should not be analyzed solely as a pricing issue. What is at stake is a broader set of relationships between innovation, investment, access, competitiveness, sustainability and industrial policy.
In this context, Portugal has significant assets: pharmaceutical exports rose from €823 million in 2014 to €4.8 billion in 2025, while patient participation in clinical trials reached around 5,900 people in 2024.
The challenge is to turn these assets into a more integrated strategy, capable of strengthening Portugal’s position as a destination for investment, clinical research, manufacturing and innovation.
“A country that decides on time is a country worth investing in.”
The meeting ended with a cross-cutting message: faced with a transformation that goes beyond Portugal’s borders, Portugal will have to define its own response, bringing together access to innovation, the sustainability of the NHS and the ability to attract investment and knowledge.
AmCham Portugal will continue to promote this dialogue between Portugal and the United States, bringing together companies, decision-makers and experts and contributing to an informed discussion on the challenges shaping the future of health.
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