In an effort to battle against what members feel is an existential threat to their businesses, a group of 10 domestic biotech companies has launched the Midsized Biotech Alliance of America with a focus on contesting the Trump administration’s Most Favored Nation (MFN) drug pricing policy.
MBAA members, which consist of companies like Acadia Pharmaceuticals, Madrigal Pharmaceuticals and Travere Therapeutics, feel vulnerable to MFN, which seeks to lower U.S. drug prices by aligning them with the lowest prices paid by comparable nations. The midsized members are fearful if MFN targets their drugs, the resulting loss in profits could spell the end of their enterprises.
“MFN would destroy biotech innovation in this country,” MBAA spokesperson Alanna Temme told Fierce Biotech. Temme is also the founder of healthcare advisory firm LMH Strategic Solutions.
Introduced in May 2025 by way of executive order, President Donald Trump’s MFN push has so far secured drug pricing pledges from more than a dozen of the world’s biggest pharmaceutical companies, with those drugmakers often winning immunity from the administration’s import tariff threats in the process. While large drugmakers have taken the threat in stride, the pricing policy could introduce more severe implications for smaller-scale biopharmas.
The new coalition consists of members that have already invested years in R&D and have marketed products to show for it, but that at the same time, lack the wide commercial portfolios of large-cap pharmas.. MBAA didn’t share specific criteria for inclusion, but other members include Alkermes, Alnylam, Ardelyx, BioMarin, Exelixis, Incyte and Neurocrine Biosciences.
Temme explained that midsize biotechs often target unmet needs and have significant risk capital requirements, and that their limited reach makes them particularly vulnerable to MFN policies.
According to the MBAA, its member companies represent $7 billion in annual U.S. R&D investment, employ 12,000 people and have brought 30 therapies to market, with nearly 100 more in the pipeline.
But the road to profitability is a slow one. The organization says it takes an average of 25 years for its members to turn a profit on their drug candidates. R&D costs, multi-phased clinical trials, attaining market share and scaling manufacturing all factor into the extended timeline that it typically takes to get out of the red.
With long timelines and narrow windows for success, Temme didn’t mince words when discussing the logical impacts of MFN on medium-sized biotechs: “MFN could wipe them off the map,” she said.
MFN carries a higher risk for midsize American biopharma jobs and organizations than smaller biotechs and larger pharmas, Temme explained. Smaller startups are years away from having to worry about profit loss from the MFN policy, while Big Pharma companies can make up for lower prices on some drugs by making more on others.
Related
But midsize biotechs don’t have that kind of flexibility, Temme said. Often boasting just one marketed product, members felt they needed more protection and formed the MBAA to advocate for themselves. With PhRMA representing larger organizations and BIO undertaking advocacy for the industry at large, the MBAA aims to fill that midsized advocacy gap.
The MBAA aims to educate the public and policymakers and encourage a free-market solution to drug development, Temme says. Members believe MFN is a destructive policy, but their efforts have been hampered by industry giants like AstraZeneca, Eli Lilly, Novo Nordisk and Pfizer signing MFN agreements with the Trump administration in recent months.
While individual pharma companies haven’t been too publicly negative about MFN, the MBAA’s arguments against the policy echo those shared by the Coalition Opposing the Codification of Most-Favored-Nation Prescription Drug Pricing, which released a letter earlier this month warning that the policy would hamper innovation and American competitiveness.
“MFN would reduce access to new cures and reduce U.S. global competitiveness, ceding ground to China,” the coalition wrote.
The division between the companies that have signed MFN deals and MBAA members will make the organization’s advocacy efforts more difficult and damage the overall industry, Temme said.
“One size does not fit all,” Temme explained. “Midsize biotechs can’t survive a change like that. MFN has fractured the industry, which is never good.”
The MBAA’s fears may already be coming to fruition. Though analysts have said the MFN order is more bark than bite and subject to future legal challenges, American biotechs have become increasingly wary of licensing products to European partners, fearing they may run afoul of MFN.
While the group is “laser-focused on MFN,” Temme also noted the impact that MBAA members and their peers have on American industry at large. Calling the midsized biotechs “the heart of American innovation,” she said safeguarding a strong U.S. biotech ecosystem could help bolster an industry that has seen turmoil domestically, while China continues its strong biotech growth and Europe reprioritizes to make itself more competitive.
“Midsize biotechs are the lifeline to make sure we maintain being the world leader in healthcare innovation,” Temme says.