The mechanism: Executive Order 14297 directs HHS to set U.S. list-price targets pegged to the lowest prices paid in comparable developed nations — then gives itself a ladder of enforcement if manufacturers don't fall in line: direct-to-consumer sales at MFN prices, rulemaking, FDA import waivers from low-price countries, and DOJ/FTC antitrust pressure. The order doesn't touch dosage, patents, or FDA approval science — it touches list price, the one number that determines how many dollars flow from a drug's U.S. sales into a company's income statement. That makes exposure a function of revenue concentration, not therapeutic quality. A company with one or two blockbusters priced far above ex-U.S. benchmarks eats a bigger proportional hit than one whose sales are spread across dozens of smaller products, biosimilar-resistant biologics, or drugs already past their patent cliff (where MFN pricing barely moves a generic's economics).
Who cashes in