Secret Pfizer and Lilly contracts favor drugmakers over patients, records show

Confidential drug-pricing agreements between the Trump administration and two of the world’s largest pharmaceutical companies contain terms that let the companies raise prices overseas and shield them from tariffs, according to contracts obtained by the consumer advocacy group Public Citizen.

Public Citizen obtained the Pfizer and Eli Lilly agreements through a Freedom of Information Act lawsuit after the administration failed to respond to the group’s initial records request. The documents were released nearly six months after that lawsuit was filed, and about ten months after the White House first announced the deals. Pfizer’s letter of agreement was announced September 30, 2025, with a definitive contract executed February 23, 2026. Lilly’s initial letter of agreement came November 6, 2025, followed by its own final agreement on the same February date. Twenty-seven pharmaceutical manufacturers in total have signed similar “most favored nation” pricing deals with the administration, which are meant to tie U.S. drug prices to the lower prices those companies charge in other wealthy countries.

The released contracts show Lilly’s agreement permits the company to stop supplying a drug to a country used as a price reference, removing that country’s lower price from the calculation that sets the U.S. “most favored nation” price. Pfizer’s agreement requires the company to share a portion of any increased revenue from overseas price hikes with the U.S. government, though the specific formula for that arrangement remains redacted in the released documents.

Both companies also secured tariff protections. Pfizer received relief tied to manufacturing commitments, according to Commerce Department documents reviewed by Public Citizen. Lilly’s exemption exists only as a draft agreement in the released files; a White House document from April indicated Pfizer still lacked a final tariff agreement as of that date.

The contracts also carve Lilly’s blockbuster obesity and diabetes drugs, marketed as Zepbound and Mounjaro, out of discount requirements under a Medicaid demonstration program known as the GENEROUS model. An analysis by Thomas Hwang of Harvard Medical School, provided to Public Citizen, found that the exclusion alone could cost the program up to $300 million in first-year savings. If Novo Nordisk’s competing GLP-1 drugs are also excluded, Public Citizen says combined lost savings could reach $1 billion to $1.7 billion, or 12 to 20 percent of the program’s projected $8.6 billion in total savings.

“Trump’s drug pricing deals are a mirage, designed to convince Americans that he’s taken significant action on drug pricing while creating minimal if any downside for Big Pharma,” Peter Maybarduk, Public Citizen’s access to medicines director, said, according to Raw Story.

The documents also show Lilly received National Priority Vouchers from the Food and Drug Administration, which allow a company to fast-track the agency’s review of a future drug application, as part of the incentives tied to its pricing agreement.

Separately, the documents show that under Switzerland’s mandatory health insurance system, about one-third of new innovative medicines were not submitted for coverage between January 2025 and June 2026, a pattern Public Citizen links to drugmakers’ concerns that lower Swiss prices could be used to justify lower U.S. reference prices under the administration’s policy.