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Ernst & Young LLP found that a total of 16 medicine launches had been cancelled in Canada because of MFN, among 31 different companies.Ryan Remiorz/The Canadian Press
The United States has, by far, the highest average drug prices in the world. And for nearly two years, President Donald Trump has said he would drive those prices down through the pursuit of a most-favoured-nation (MFN) policy that would force drug companies to lower prices in the U.S. and raise them in other countries.
Canada is one of the countries targeted by the U.S. initiative. The pharmaceutical industry has warned that Canada will see fewer drugs available for patients and will have to accept higher prices as a result.
But has Canada actually felt the bite of MFN so far? The evidence has been mixed.
While 26 drug makers signed MFN deals with the White House as of August, the companies have been reticent to tie specific drug launch decisions to the policy. Instead, they have spoken generally in support of MFN and tied it to more long-standing concerns with Canada, such as the long wait – up to two years on average – to be approved by regulators and insurers.
“MFN accentuates the vulnerabilities of Canada when it comes to drug launches,” said Bettina Hamelin, chief executive officer of Innovative Medicines Canada, the main lobby group for patented drug makers.
Earlier this year, Innovative Medicines Canada commissioned Ernst & Young LLP to conduct an anonymous survey of its members. EY found that a total of 16 medicine launches had been cancelled in Canada because of MFN, among 31 different companies. No specific products were named.
At the same time, Canadian government bodies say they are not seeing a slowdown in the number of drugs that have applied to launch here.
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Canada’s Drug Agency (CDA), which evaluates pharmaceuticals on factors such as cost effectiveness, says it is on track to review 100 drugs this calendar year, a 27-per-cent increase over the 79 reviews conducted in 2025. CDA reviews drugs after Health Canada has approved them for safety and efficacy.
CDA issues non-binding recommendations for public insurers, which then negotiate prices with drug companies through a body called the pan-Canadian Pharmaceutical Alliance (pCPA).
The other major place where MFN would show up is in those negotiations. The industry points to the fact that 22 per cent of listing negotiations in 2026 so far have ended up without a deal – twice as many no-deals as the year before. That, on its own, could suggest drug companies are demanding prices closer to what they are charging in the U.S., which is higher than Canadian public insurers are willing to pay.
But, as pCPA CEO Mauro Chies points out, that a 22-per-cent failure rate is in line with many other recent years, such as 2019 and 2022.
MFN “has come up at the negotiating table,” Mr. Chies said. “I don’t think to the prevalence that some people are making it out to be, to be quite honest.”
He said MFN has been mentioned a couple of times this year, but he added that there are many reasons why a negotiation can conclude unsuccessfully – which speaks to the complexity of the decisions drug companies make when deciding on a price and that public insurers make when deciding how much money to budget for a particular treatment.
One example of that complexity is Vanrafia, a drug produced by Novartis to treat a type of kidney disease called immunoglobulin A nephropathy (IgAN). Novartis announced in July that Vanrafia had been approved by Health Canada, but weeks later the company told CityNews it had decided not to launch the drug in the Canadian market.
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Canada’s Drug Agency (CDA) says it is on track to review 100 drugs this calendar year, a 27-per-cent increase over the 79 reviews conducted in 2025.Jacques Boissinot/The Canadian Press
The company itself has not said the decision was because of MFN − and Novartis did not respond to The Globe and Mail’s questions. But in a government submission in September, the lobby group Innovative Medicines Canada cited the drug as one of three examples of products not launching in Canada because of MFN.
(Another drug cited by Innovative Medicines Canada – an ovarian-cancer treatment called Elahere – should launch in Canada soon because manufacturer AbbVie announced in October it had signed a deal with public insurers after all.)
But there may be other reasons, too, for the Vanrafia decision. It is one of about half-a-dozen drugs to treat IgAN that have launched in the U.S. and not in Canada. An analysis of three IgAN drugs (not including Vanrafia) published by the Institute for Clinical and Economic Review, a U.S. non-profit that does an analysis similar to Canada’s CDA, found the products provided a clinical benefit but questioned their value for money. One of the drugs costs US$292,500 a year. (Vanrafia has an annual U.S. list price of US$171,493, according to its website.)
“Manufacturers should set prices that will foster affordability and good access for all patients by aligning prices with the patient-centered therapeutic value of their treatments,” the non-profit’s review says.
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In Canada, such an analysis is required before a public insurer will consider listing a drug; in the U.S., where private insurance is more widespread, such an analysis is not required before a drug is made available to patients.
Ruchi Ambike, a Canadian patient advocate who herself has IgAN, said the disease has left her with only 19 per cent of her kidney function and a need to carefully manage her limited energy each day.
She would like to see some of the IgAN drugs come to Canada. Instead, it is more common for IgAN patients in Canada to be prescribed a steroid like prednisone, she said, which can help manage inflammation but also comes with possible side effects like swelling.
“We don’t have any of the medications that actually target and therefore stop the progression of IgA nephropathy,” she said.
In her conversations with drug companies, Ms. Ambike said she heard concerns from them about getting their drugs reimbursed from public insurers – especially as their drugs would be far more expensive than the pennies-a-pill cost of generic prednisone.
Ramy Saleh, medical director of oncology clinical trials at The Research Institute of the McGill University Health Centre, said he sees this issue of high price tags particularly with cutting-edge drugs for cancer patients. He said he thinks some drug companies have used Mr. Trump’s policies as cover to try to extract unnecessarily high prices in countries like Canada.
“I can’t imagine, if a drug is going to cost half a million dollars a year per patient, how are we going to sustain this?” Dr. Saleh asked.
At the end of the day, Ms. Ambike said, it is patients who lose out the most.
“We really need to look at Canadian patients as worthy and deserving of life-saving treatments, not just market value or numbers,” she said.