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Wednesday has wheels!
Hello, Curse and Coffee friends,
Today, we explore the continuation of the big pharma rip off.
Hit reply and let us know what you think (we read all of your kind words).
Coffee at the ready…
The Big Sip
The take: Pharma got tariff exemptions. Patients got January.
What happened: All 16 drug companies that signed "Most Favoured Nation" deals raised prices on some drugs in the first two weeks of 2026.
Why it matters: The deals covered Medicaid and cash payers. List prices, which drive copays and coverage decisions, were never part of the bargain.
What to watch: TrumpRx.gov launches this month. The 872 drugs that just got more expensive won't be on it.
The White House called list prices irrelevant. Your copay didn't get the memo.
Sponsor Break
Before we slurp into today’s brew…
Here are some wordies from today’s sponsor.
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Here’s Your Brew
The only drugs that saw real price cuts this month?
Four medications from Medicare negotiation, a Biden-era policy that Trump once promised to kill.
Medicare's negotiated prices on those drugs fell 38–79%. Four also cut their list prices, meaning savings beyond Medicare.
The other six didn't budge.
MFN deals offered pharma tariff exemptions in exchange for voluntary discounts on a narrow slice of the market.
List prices were explicitly excluded.
Those are the numbers that set copays, shape formularies, and hit the uninsured hardest.
Twenty-seven million Americans don't have health insurance.
For them…
The list price is the only price.
Rebates are a rumour.
Two Sides, One Mug
Pro: MFN deals guarantee the lowest-in-the-world pricing for Medicaid patients on specific drugs. Nearly 80 million people. Real savings. Not nothing.
Con: List prices drive the whole system. Ignoring them while claiming victory is a press release, not a policy.
Our read: Voluntary deals with no list-price teeth are what you get when the ask is optics and the offer is tariff relief.
Receipt of the Day
46brooklyn January 2026 Price Tracker
The cleanest public record of what pharma did versus what they announced. 872 increases. 18 cuts. Four of those cuts came from Medicare negotiation, not the MFN deals. Bookmark it before your next prescription refill.
Spit Take
Deals signed: 16. Prices raised: 872.
Your Coffee Break Links (and water cooler chatter)
Demerol up 289% — Hospital drugs got hit hardest. Morphine and hydromorphone saw fourfold increases. The median hike was 4%, but the outliers tell the story. CNN
Medicare negotiation is already winning — Out-of-pocket costs on the 10 negotiated drugs will fall about 50% this year. The policy Trump trashed is outperforming the one he's selling. AARP
Rebates don't help if you're uninsured — Pfizer says net prices are what matter. True if you have coverage. The 27 million who don't are still paying list. BioPharma Dive
Join your team of caffeinated skeptics.
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One bold take, the best counter, and the receipt(s) that prove it (all in sixish minutes).
Mugshot Poll 📊
What's the real "greatest victory for patient affordability"?
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Enjoy your Wednesday, keep it caffeinated.
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