China is the reason why the US’s Most Favored Nation drug pricing experiment will likely be short-lived

China is the reason why the US’s MFN drug pricing experiment will likely be short-lived 中国正是美国“最惠国”药品定价政策昙花一现的关键因素 By Peter Kolchinsky POLICY | BIOTECH | FINANCE Photo by Manish Tulaskar on Unsplash January 21, 2026 China is well positioned to fill the biotech innovation gaps in the global economy that the United States leaves behind. America’s “most-favored nation” drug pricing policies will present China with the opportunity to serve the world’s need for innovative medicines if the US continues to isolate itself. With that isolation will eventually come higher domestic prices for the R&D and medicines Americans rely on until the American public demands that we, too, buy our innovative meds from China. Alternatively, the US could continue to work with China to accelerate global R&D while requiring that supply chains ensure against geopolitical disruption through domestic manufacturing of our medical standards of care. Meanwhile, to get other countries to pay their fair share for medicines, the US should rely on trade pressure, not MFN. 摘要：和全球经济中的其他行业一样，如果美国在全球生物创新行业中选择主动退场，中国会很自然地借助自身优势，承担填补这一市场空缺的角色。随着中国生物创新的崛起，美国政府推行的药品定价“最惠国”（MFN）”政策，若继续推进，将会让美国在世界创新体系中愈发孤立，给中国创新者提供历史性机遇，满足全球市场对于创新药的需求。随着这种自我孤立的不断深入，为美国公众提供其所依赖的生物技术创新企业最终会面临更高的研发成本，药价日益上涨。长期来看，成本压力将会最终促使公众开始要求我们也必须从中国采购社会所需创新药。当然，自我孤立并不是美国的唯一选择。另一条更具有建设性的路，是以合理和共赢的方式和中国继续合作。在和中国合力加速全球生物制药研发的同时，完善美国国内药物的生产供应链，最大程度地抵御地缘政治冲突对美国的医疗服务和患者造成影响。与此同时，我们可以通过贸易谈判和施压，而非“最惠国”药品定价政策，来推动其他国家为全球药品创新药作出更合理的支付。 I think this becomes especially clear when you read this as a translation from Chinese and envision this being presented in China, by a Chinese executive, to an audience of Chinese biotech innovators. 对于英文版的读者而言，如果将原文理解为一个中国的企业高管用中文向中国的生物创新工作者所做的战略性阐述，那么其中的逻辑会显得格外清晰和合理。 美国的失策: 中国的历史性机遇 Mistake by US – Advantage to China 美国政府的政策失误在于： 要求制药公司对创新药在其他同等富裕国家实行与美国相同的药品定价，即所谓的“最惠国待遇”政策。 America’s mistake lies in the following: The US requires pharmaceutical companies to apply US-level drug pricing to other wealthy countries – the so-called “Most-Favored Nation” pricing policy. 结果：欧洲国家、澳大利亚、加拿大、日本等发达国家不会接受以美国市场的定价来对创新药提供覆盖和支付。这就迫使制药公司必须在以下两者间作出选择：要么以高价仅在美国市场销售，要么以较低价格在全球市场同步销售。对于非中国籍的生物制药公司而言，高成本结构和美国的利润所占的高比例，将会迫使公司选择以高价仅在美国市场销售，即便这意味着在全球范围内部分利润的损失。 As a result: If European countries, as well as Australia, Canada, and Japan, are unwilling to accept higher, US-based prices, pharmaceutical companies will be forced to choose between two options: selling at US prices only in the US market or selling globally at lower prices. For non-Chinese biopharmaceutical companies with relatively high cost structures, prioritizing the US market remains a rational decision, even if it means sacrificing some global profits. 短期机会： 中国生物技术公司可以凭借成本优势，快速完成同类或相似药物的研发和规模化生产，并将这些药物以更具市场竞争力的价格占领美国以外的全球市场，从中获利。由于美国仍是全球范围内创新药最大的市场，中国公司可以同时在美国市场中继续竞争。然而，在初期，美国政府极有可能会限制或阻止中国药物进入本土市场。 Near-term opportunity: Chinese biotechnology companies can discover, develop, and scale comparable drugs more efficiently and profitably sell them in other countries at the lower prices those countries are willing to pay. Chinese companies can also continue to try to compete in the US market, which is admittedly the single largest market for novel medicines. It is, however, possible that the US may restrict or block Chinese drugs from entering its domestic market. 长期机会：如果西方（非中国籍的）的创新者的药物的研发主要面向美国市场，基于伦理和商业的考虑，这些药物创新企业将很难以在美国以外那些其无意销售该药物的国家和地区开展临床试验。这会减缓这些药物的研发进程，提高研发成本，最终显著增加美国社会对于这些药物的支出成本。其效果其实无异于坚持要求所有产品都完全在美国本土生产。当美国民众看到其他国家能够更快地、以更低成本获得同样或更好的药物时，美国市场对于中国药物的需求上升将不可避免。为了控制医疗支出，美国市场最终将会对中国生物技术公司进一步开放。在此之前，美国以外的世界市场的需求，包括中国国内的需求和对于其他国家的出口，足以为中国的生物技术行业提供源源不断的创新动力。 Long-term opportunity: As Western companies increasingly pivot to developing their medicines solely for the US market, companies will find it difficult to conduct clinical trials in countries where they have no intention of selling those drugs. This raises the cost and slows the pace of R&D, significantly raising the overall cost of drugs in the US, an effect that is essentially no different from insisting that all products be manufactured entirely within the US. When the American public sees that other countries are able to access the same or better drugs more quickly and at lower cost, demand for Chinese drugs will inevitably rise. To control healthcare spending, the US market will ultimately open to Chinese biotechnology companies. Until that day, the rest of the world is large enough to incentivize the Chinese biotechnology sector to keep innovating, both for export and for China’s patients. 结论：“最惠国”药物定价政策继续推行将会为中国创造历史机遇，使中国加速成为全球药物创新的主要力量之一。 Conclusion: Should MFN remain the US’s most-favored drug pricing policy, China is well positioned to quickly fill the gap, more quickly reaching its goal of becoming a major source of biomedical innovation for the global market. A better proposal 一个更好的提案 This one will be in English first and then Chinese. 本方案将先以英文呈现，然后附上中文翻译。 So here’s an alternate proposal, one that takes into account the reality that the genie is out of the bottle and no amount of shunning by the US will prevent China from leveraging its efficiencies to cater to global demand for novel medicines. 实际上，不管美国如何抑制，中国最终都会在生物制药方面崛起，利用自身优势成为全球创新药的主要动力来源之一。如果我们正视这一现实，我们可以提出更有建设性的方案。 Invent globally, manufacture locally 创新全球化，生产本地化 Open and productive East-West R&D collaboration should continue. Western companies with a global view, under constant competitive pressure to be maximally efficient, will continue to engage in drug discovery, preclinical testing, and trials through Phase 2 proof of concept wherever in the world the work can be done most efficiently, including in China. They will continue to in-license drug candidates from China. Even after doing all it can to streamline discovery and development in the US, the US simply can’t afford to do without lower costs overseas and particularly “China Speed” if it wants to keep R&D costs and timelines down so as to preserve returns on investment in drug R&D. Any company that doesn’t rely on China Speed may find it can’t compete with those that do. So China Speed is too useful a tool to give up. 我们应当继续保持东西方在研发领域的开放合作。在持续的市场竞争的驱动下，具有全球化视野的西方公司会在药物研发的各个关键环节 （包括药物发现、临床前研究、直至 II 期概念验证的临床试验），在包括中国在内的全世界范围内寻找最佳合作伙伴，来最大化生产效率。这些公司也会不断地从中国引入创新的药物的海外开发销售权。从这些公司的角度来看，为了保持药物研发资本的回报，他们必须保持低成本和短时间周期的研发。要达到这一目的，美国必须借力于其他国家在研发的成本优势，其中尤为突出的是“中国速度”。任何不借助中国速度的公司，都极有可能发现自己无法和那些善用中国速度的竞争对手抗衡。因此，中国速度对于西方企业是一个取得商业成功不可或缺的工具。 Prior to US approval, medicines must still be tested in diverse populations of patients outside of China that are representative of US demographics. 新药在获得美国FDA批准之前，仍然必须在中国以外、能够代表美国患者特征的多样化人群中进行临床测试。 To ensure that the US need never fear disruption of its medical standard of care, it would make sense for US policy to mandate that approved medicines are manufactured outside China, and maybe even on US soil (though environmental regulations currently make that impractical and we’ll need to innovate considerably on manufacturing). This policy may even require that companies that serve the US market have ownership and/or governance without ties to China’s government. But that should not preclude paying Chinese innovators and investors milestones and royalties if they were involved in the original discovery and early development of a medicine. 为了确保美国永远不必担心其医疗服务标准受到药物供应中断的影响，美国政府可以制定政策，要求供应美国市场的获批药物必须在中国以外生产，甚至可以要求在美国本土制造。当然，为了实现美国本土生产，我们还需要在环境管理条例有所改革和在制造工序上大幅提高创新。政策还可以进一步规定，服务于美国市场的公司，其所有权结构和管理团队不能与中国政府存在关联。虽然我们需要政策改革来保证美国的国家利益，但对于在新药发现和研发中作出贡献的中国的创新者和投资者，我们应当依据药物发展的社会价值给予他们回报。 To address the problem of other countries freeriding on the US market by undervaluing medicines and paying much less for them than America does, the US government should apply trade pressure on those countries, much as the US did to get those countries to spend more on defense. Companies already have a profit motive to charge higher prices in other countries and, despite playing hardball and withholding their medicines (e.g., drugs often launch later in Europe and Canada than in the US), in most cases they simply lack the leverage to get those countries to pay more. Other countries can and do just say no, but those medicines eventually go generic and become globally accessible at low prices. And now, as you can see, Chinese companies will sell similar novel medicines even before Western versions go generic. So old fashioned trade pressure would have a better chance of getting other countries to pay more for medicines than MFN policy, without the unintended consequence of the US simply ceding ex-US healthcare markets to China’s biotech sector. 为了解决其他国家通过低估药品社会价值来压价、以远低于美国的价格购买药物，从而“搭便车”美国市场的问题，更合理的做法是像当年促使这些国家增加国防开支那样，对其施加贸易压力。创新药企业原本就有在其他国家收取更高价格的利润动机，尽管它们在和许多国家药价谈判中采取强硬策略、延迟甚至暂缓药物上市（例如许多药物在欧洲和加拿大的上市时间往往晚于美国），但在大多数情况下，企业并不具备足够的谈判杠杆来迫使这些国家支付更高价格。这些国家完全可以、也确实在现实中会直接拒绝涨价要求，等到药物进入了仿制药阶段，它们就可以以低价来获得这些药品。然而在当下，随着中国生物制药创新的崛起，在西方创新药尚未进入仿制阶段之前，中国已经能够以更具市场竞争力的价格销售具有相似疗效的创新药物。因此，与“最惠国”（MFN）定价政策相比，传统的贸易施压方式更有可能促使其他国家为药品支付更高价格，同时还能避免一种非预期的政策后果：将海外创新药市场直接拱手让给中国的生物技术产业。 Key insights 核心观点 It’s easy to mistake the US being the largest market for novel medicines with America’s biopharmaceutical companies, academic research institutions, and health system being essential for developing medicines for the rest of the world. The fact is, the US is the largest market for novel medicines because we value novel medicines and what biomedical progress can do for us more than any other nation. But the US is no longer essential for developing medicines for the rest of the world nor is it even an efficient country in which to do much drug R&D. Drug development is more expensive and slower in the US than in other countries. For example, we have less than 5% of the world’s population, and it would take too long to enroll trials just in the US. 人们很容易将美国作为全球最大创新药市场这一事实，误以为是源于美国的生物制药企业、学术研究机构以及医疗体系在为世界其他国家开发药物方面不可或缺的地位。事实上，美国之所以成为全球最大的创新药市场，是因为我们比任何其他国家都更重视创新药物，以及生物医学进步能够为我们带来的价值。然而，在当下，美国已不再是为世界其他国家开发药物中必不可少的国家，甚至也不再是开展大量药物研发的高效地点。与其他国家相比，在美国进行药物开发的成本更高、周期更长。例如，美国人口仅占全球总人口的不到5%，如果临床试验仅在美国开展，患者入组将耗费过长时间。 So we need novel medicines, we value novel medicines, and we have good and financeable ideas for how to create them, but we can’t realistically do it alone. And yet MFN would leave us to develop medicines for ourselves by ourselves. That’s as untenable a proposition as expecting the US to manufacture everything that it consumes – cars, computers, steel, coffee, toys, etc. The prices of those products are not the same in other countries, and yet America, prudently, doesn’t impose MFN on other industries that sell them. 因此，我们确实需要创新药，也重视创新药，并且在如何开发创新药方面拥有成熟且具备融资可行性的理念，但我们不可能不切实际地仅凭自身力量来完成整个新药的研发和上市。然而，“最惠国”（MFN）定价政策却会导致美国在药物创新上被迫独自承担研发责任，并最终仅服务于美国本土市场。这种设想与要求美国自行生产其所需的一切消费品的主张, 汽车、计算机、钢铁、咖啡、玩具等, 同样站不住脚。和创新药一样，这些产品在其他国家的价格和在美国并不相同，但美国在实践中也审慎地没有对销售这些产品的其他产业实施“最惠国”定价政策。 If policymakers wish to make medicines more affordable for patients, it would make more sense to cap what insurance plans are allowed to charge patients out of pocket. Novel medicines, all combined, represent just 8% of what the US spends on healthcare and are readily affordable when we pay for them together, out of premiums, instead of burdening the few among us who happen to need them today with high, sometimes unaffordable out-of-pocket costs. Lowering out-of-pocket costs will avoid under-treatment, which is good, and won’t drive up premiums due to over-utilization because most medicines are not the kind anyone would even want to take unless they had to and, where there’s doubt, plans still can use prior authorization to ensure that prescriptions are appropriate. Affordability for patients is therefore an issue of insurance design. 如果政策制定者希望提高患者对药物的可负担性，更合理的做法是对保险计划向患者收取的自付费用设定上限。总体而言，创新药物仅占美国医疗总支出的约8%；当这部分成本通过保费在全体投保人之间共同分担时，其实是完全可以负担的。这些支出不应当以高昂、甚至有时难以承受的自付费用的形式，由少数恰好在当下需要这些药物的患者来承担。降低患者自付费用可以避免因无法负担而导致的治疗不足，保证及时治疗；同时，也不会因为过度使用药物而推高保费。其原因在于，在没有必要的情况下，对于大多数的药物，人们是不会主动过度使用的；而对于可能存在使用不合理的药物，保险公司仍可通过事前授权等管理工具，确保用药的合理性。因此，患者对创新药的可负担性问题，本质上是一个保险制度设计的问题。 And compared to the cost of a disease left untreated, novel medicines are bargains even at what people think are high prices. They are bargains because they go generic, unlike disease, hospitals, or anything else in healthcare. Only medicines drop in price. And if they don’t drop in price after their patents expire, which can happen with biologics, we already have tools like Medicare Negotiation as a backstop to force prices down after 13 years. 与疾病得不到及时治疗所带来的社会成本相比，即便是在许多人看来价格不菲的情况下，创新药物依然是“物有所值”的选择。这是因为，与疾病本身、医院服务或医疗体系中的其他支出不同，药品最终会进入仿制阶段并显著降价, 只有药品具备这种价格随时间下降的特性。即便在某些情况下（如生物制剂）专利到期后价格下降并不明显，我们也已经拥有相应的政策性工具作为兜底，例如“医疗保险药品价格谈判”（Medicare Negotiation），可在药品上市约13年后推动价格下调。 Arguing that the US subsidizes medicines for other countries ignores how much the US depends on other countries to make biomedical R&D financially viable. Other countries don’t pay as much for medicines but they allow drug companies to conduct trials on their patients because they expect to be able to access those medicines once they are approved. Other countries don’t charge drug companies nearly as much to enroll a patient into a clinical study as US medical institutions charge. In that way, other countries subsidize R&D costs to benefit Americans. It’s all how you look at it. 只单方面强调美国在为其他国家补贴药品成本的说法，忽视了在生物医药研发的财务可行性上美国对其他国家的高度依赖。其他国家虽然并未为药品支付同样高的价格，但它们允许药企在本国患者中开展临床试验，前提是这些药物一旦获批，其本国患者能够获得相应的治疗机会。此外，其他国家在临床研究中为药企招募一名患者所收取的费用，也远低于美国医疗机构的收费水平。从这个角度看，其他国家实际上是在通过降低研发成本来补贴生物医学研发，从而惠及美国患者。归根结底，这取决于你如何全面看待在研发过程中的投入产出。 We should value these contributions before imposing MFN and potentially losing them. It’s like we’re all in a canoe together rowing away from the waterfall of disease and even though Canadians and Europeans and Australians don’t row as hard as Americans, however much they row is still useful. The goal is to get them to row harder – to pay more – but MFN policy will only make them jump out of our canoe. Americans won’t even get the satisfaction of watching the freeriders go over the waterfall because China is offering them a ride in their more efficient canoe. Ideally, we would all row together proportionately to our economic strength (i.e., GDP/capita-adjusted prices), as MFN architects desire. But even if other countries won’t row as hard, the US is still better off having them stay in our canoe, rowing however hard they are willing, while using trade diplomacy to get them to row harder. 在继续推进“最惠国”（MFN）定价政策，我们应当充分认识到其他国家在整个研发过程中已经作出的贡献，正视我们可能因这一政策而失去这些贡献的可能性。这就好比我们所有人都坐在同一条独木舟上，正合力划桨、试图远离疾病这道瀑布。即便加拿大、欧洲和澳大利亚划桨的力度不如美国，但他们无论划得多用力，都是有价值的。真正的目标，是促使他们划得更用力, 也就是为药品支付更高的价格；但MFN政策只会让他们直接跳下我们的独木舟。更糟糕的是，美国人没有意识到这些“搭便车者”将不会被瀑布吞没，因为中国正邀请他们登上一条更高效的独木舟。理想状态下，正如MFN政策设计者所期望的那样，我们应当按照各自的经济实力成比例地共同划桨（例如以人均GDP调整后的药价作为参考）。但即便其他国家仍不愿像美国那样用力划桨，只要他们还愿意留在同一条独木舟上、尽其所能出力，美国也仍然更为受益；与此同时，我们也可以再通过贸易外交手段推动他们承担更大的责任。 However well-intentioned in terms of getting other countries to pay their fair share for biomedical innovation, MFN forces companies to try to negotiate with the governments of single-payor nations and therefore can’t be expected to have much bite. China’s growing biotechnology capabilities and global ambitions render MFN toothless, ensuring that it only backfires on the US with worse outcomes for US patients and higher costs for all Americans. More on how to solve international freeriding with trade diplomacy here. 尽管“最惠国”（MFN）定价政策的目标是促使其他国家为生物医学创新承担其应有的责任，但该政策实际上迫使企业不得不与每一个由单一支付体系的国家的政府进行谈判。在面对一个国家的购买力的压力下，一个的企业的谈判力很有限。与此同时，中国不断增强的生物技术能力及其全球化布局，使得MFN政策更加形同虚设，结果只会对美国产生反噬：既损害美国患者的利益，又推高美国社会的成本。关于如何通过贸易外交手段应对国际“搭便车”问题，详见此处。 A final thought on biodefense 关于生物防御的最后一点思考 I’ve heard some people worry that if the US continues to engage with China’s biotech sector to develop medicines, there will be biodefense spillovers. The US will lose the ability to protect itself against bioweapons and China will become better at making them. 我听到一些人担心，如果美国继续与中国生物技术产业合作开发药物，可能会产生所谓的“生物防御外溢效应”：美国的防范生物武器的能力将会被削弱，而中国则会变得更擅长制造它们 Firstly, I don’t think that most policymakers really believe this. And most national security concerns related to biotechnology focus on ensuring China doesn’t have access to the genomes and health records of US residents. Sharing this so-called “biological intelligence” is not necessary for the US to benefit from collaboration with China on drug development. If the US government really thought that developing novel medicines is key to excelling at biodefense, we wouldn’t be publishing our patents and disclosing our scientific progress. You can’t practically hold back all biomedical science to avoid spreading techniques that could be used for making bioweapons. 首先，我并不认为大多数政策制定者真的相信这一点。从国家安全的角度来说，我们需要保证中国没有掌握生物情报，即美国民众的基因库和健康记录。在和中国在生物研发合作并不要求我们分享这些保密的信息。而且如果美国政府真的认为，开发各类创新药物是生物防御能力的关键，那么我们就不会公开发表专利、披露科研进展。事实上，根本不可能为了防止某些技术被滥用于生物武器，而全面封锁整个生物医学科学领域。 Secondly, if China or any other country wanted to make and deploy bioweapons, they already can. It might shock you to know that actually, just like any kid can now write a computer virus, the technology to make bioweapons is readily available today to any graduate student anywhere in the world. For example, one can readily recode the sequences of many bacteria, viruses, and fungi to be resistant to known antibiotics, antivirals, and antifungals. The challenges lie elsewhere. 其次，如果中国真的想要制造并部署生物武器，它现在就已经具备这种能力。也许会让你感到震惊的是，事实上，就像如今任何孩子都能写出计算机病毒一样，制造生物武器所需的技术，今天对世界上任何地方的研究生来说都是触手可及的。比如，人们已经可以相对容易地重新编码多种细菌、病毒和真菌的基因序列，使其对现有的抗生素、抗病毒药和抗真菌药产生耐药性。真正的难题并不在这里。 So if we’re worried about bioweapons, then we should be fielding focused efforts aimed at countermeasures and detection, as well as considering the game theory of deterrence. Unsurprisingly, we already do. We must continue to fund basic science in the US and study all that’s being learned all over the world, so that we, too, enjoy the biodefense-applicable spillovers from progress in adjacent disciplines. 因此，如果我们真正担心生物武器问题，就应该集中力量发展对策与检测能力，同时从博弈论的角度思考威慑机制。毫不意外的是，我们已经在这么做了。只要我们继续在美国资助基础科学研究，并系统性地学习全球范围内的新知识，那么我们同样会从相邻学科的进步中获得可用于生物防御的外溢收益。 So let’s not throw away all the advantages of working with China on making medicines that improve health and extend life out of some false notion that we can at least slow down anyone’s ability to make instruments of death. Compared to building bioweapons, saving lives is much harder. 因此，我们不应该基于一种错误的幻想, 认为我们至少可以减缓他国制造“死亡工具”的能力, 就放弃了与中国合作研发改善健康、延长寿命的药物所带来的巨大优势。和用生物武器来制造伤害相比，拯救生命，其实药要困难得多。 In closing 最后 We are globally allied in wishing for the good health of our loved ones. Let’s tap into that shared goal and continue working together towards it for as long as we can. Disease has killed far more people than all the wars in human history combined. Geopolitical tensions are nothing compared to the painful, expensive war we’ve collectively long waged against disease. For as long as we care to fight disease, we can’t afford not to collaborate on biomedical innovation. 在期盼我们所爱的人健康长寿这一点上，无论国籍，全世界都站在同意阵线上。让我们基于这一共同目标，在力所能力的范围内，继续携手合作。疾病夺走的生命，远远超过人类历史上所有战争的总和。与人类历史中长期、集体投入、痛苦而昂贵的和疾病的战争相比，地缘政治的紧张关系显得微不足道。只要我们愿意继续这场对疾病的持久战，我们就应当合力延续生物医学创新合作。 Because the path to victory is not building more hospitals. It’s inventing and developing new medicines globally. And if we are worried about supply disruption, we must ensure they can be manufactured locally. 因为通往胜利的途径不在于建更多的医院，而是在全球范围内发明和开发更多的新药。如果担心药品的供应会被中断，就必须确保这些药物具备在本地生产的能力。