Authors:  Ben Hendry, Director, Global Business Development & Ruth Howells, Country Manager, UK & Ireland

At ISPOR US 2026 in Philadelphia, one message was unmistakable: market access strategy is no longer regional. Across plenaries, panels, and payer discussions, it became clear that a European launch decision can now create global pricing consequences before the company has fully understood them.

ISPOR US 2026 showed that Europe is no longer the second act in global launch strategy. Under Most Favoured Nation (MFN), International Reference Pricing (IRP), Joint Clinical Assessment (JCA), AMNOG and rising payer pressure, Europe can define global value. US companies therefore need to design evidence, pricing and sequencing together – before the first European price lands.

For US based companies planning European launches, this represents a structural shift rather than a tactical adjustment, and places greater emphasis on markets such as Germany, where pricing negotiations are becoming increasingly pivotal in shaping global access and reference pricing dynamics. Pricing reforms, evolving Health Technology Assessment (HTA) frameworks, and increasingly interconnected and evolving policy environments mean that decisions made in Europe, carry global implications and now directly influence US pricing, revenue durability, and asset valuation. Ben Hendry, Director, Global Business Development and Ruth Howells, Country Manager, UK & Ireland share their key takeaways and the key themes from ISPOR US 2026 — and what they mean for US companies preparing to launch in Europe.

MFN is shaping the global pricing paradigm

Most Favoured Nation (MFN) pricing dominated early ISPOR discussions, signalling a fundamental change in global pricing dynamics. While the precise policy mechanics continue to evolve, the strategic direction is clear: the US is no longer prepared to sustain prices materially above international benchmarks.

A recurring sentiment from the opening plenary was that the US has historically “subsidised” global pharmaceutical pricing — a narrative now shaping payer expectations and policy thinking. The consequence is structural. MFN effectively globalises pricing by linking US prices to the lowest international reference points — frequently set in Europe. A single EU launch can now anchor US pricing.

However, this also elevates Europe’s role. European pricing decisions no longer sit in isolation — they actively shape global value perception. For companies that get this right, Europe becomes a platform to establish credible, defensible value that supports pricing discussions worldwide.

Implication: A European price is no longer local — it can set your global benchmark, including in the US. Without early modelling, one EU launch decision can lock in pricing and value across markets before you’ve had the chance to optimise it.

The lowest price market can define the global ceiling – but also signal value

ISPOR reinforced a critical reality: the lowest‑price market can increasingly set the global ceiling. This is already reshaping launch behaviour, with companies:

• Rethinking entry into lower price markets
• Managing price visibility more strategically
• Prioritising sequencing to protect global benchmarks

At the same time, Europe’s pricing environment offers more than constraint. It provides diverse market archetypes, allowing companies to test, refine, and strengthen value narratives across different payer perspectives. While affordability pressures remain high, these dynamics also create opportunities to:

• Demonstrate differentiated value
• Build robust health economic arguments
• Generate evidence that strengthens global payer confidence

Launch sequencing is no longer a regional optimisation exercise — but a strategic tool for shaping both price and perception globally.

Implication: The first low-price launch is no longer a local trade-off: it can set the global ceiling for your asset. Companies must now design launch sequencing deliberately, or risk locking in price and value outcomes across markets before they can be optimised.

Launch sequencing has become a global strategic decision

EU launch strategy is no longer tactical. It is a global strategic decision with lasting consequences. Early low‑price launches in Europe risk establishing a permanent global price floor, with direct implications for US pricing under MFN and IRP dynamics. In response, companies are increasingly reassessing traditional sequencing approaches — delaying launches in lower‑price markets while selectively prioritising higher‑value European countries.

At the same time, this strategy carries risk. Delayed access can strain relationships with payers and policymakers, heighten scrutiny, and raise concerns around patient access. Meanwhile, even historically higher price EU markets are applying increasing pressure as budgets tighten. Success now depends on balancing:

• Market prioritisation
• Price visibility and reference risk
• Long-term global value protection

Every European launch decision now echoes well beyond the region. When approached strategically, Europe is not just a constraint to manage, but a powerful lever to strengthen global pricing, evidence credibility, and long-term market success.

Implication: Launch sequencing is no longer about access timing: it is about controlling global price and value from the first move. Without a deliberate sequencing strategy, companies risk setting irreversible global price floors before they have secured optimal value.

Evidence, pricing, and access are converging — creating opportunity for differentiation

One of the clearest messages from ISPOR US 2026 was that the traditional separation between evidence generation, pricing strategy, and market access is no longer viable. Evidence expectations are diverging across regions. Regulators, HTA bodies, and payers are increasingly applying different standards for what constitutes acceptable evidence, with divergence seen across:

• Comparator selection
• Endpoint relevance
• Acceptance and use of real-world evidence (RWE)
• Approaches to uncertainty and indirect comparisons

However, this divergence also creates opportunity. Europe’s rigorous HTA frameworks can act as a global benchmark for value validation. Successfully navigating these systems can:

• Strengthen clinical and economic narratives
• Enhance credibility with global payers
• Support more consistent pricing outcomes across markets

IRP, MFN, and HTA reforms are linking evidence, pricing, and reimbursement more tightly than ever — meaning that strong European evidence strategies can deliver global returns.

Implication: Evidence is a core driver of price, access, and global value. Without early alignment across evidence, pricing, and HTA expectations, companies risk mispricing their asset or failing to substantiate value in critical markets.

Managing divergence: from risk to strategic advantage

While evidence requirements are diverging, this should not be viewed solely as risk. It represents a shift toward more sophisticated, tailored value demonstration. Companies that invest early in globally aligned evidence strategies can:

• Anticipate and address regional differences proactively
• Avoid misalignment between regulatory and HTA expectations
• Use European evidence to strengthen global positioning

The days of late-stage local adaptation are over. In their place is a need for early, integrated evidence planning that recognises Europe’s influence on global access and pricing.

Implication: Divergence is no longer something to manage late—it must be designed into evidence strategy from the outset.

A fully interdependent system

ISPOR discussions highlighted a broader truth: healthcare policy is no longer independent by market. Policy decisions are increasingly interconnected, with pricing, HTA, and trade dynamics interacting across borders. In this environment:

• Europe functions as a global leverage point
• Early decisions carry amplified downstream consequences
• Success in one market can reinforce outcomes in another

For US companies, this creates both complexity and opportunity. Europe is not just a hurdle to overcome — it is a central platform for shaping global success.

What this means for US companies launching in Europe

These shifts define a fundamentally new market access environment. Europe is no longer simply a step in the launch pathway. It is a strategic lever that shapes global pricing, access, and long-term value. When approached strategically, Europe can:

• Reinforce global value narratives
• Support more consistent pricing outcomes
• Strengthen payer confidence across markets

Before entering Europe, US companies should stress test three things:

• Their likely European price corridor,
• Their first-wave launch sequence,
• Whether their evidence package will withstand JCA, AMNOG, NICE and payer scrutiny.

European launch decisions no longer play out in isolation – they can set global pricing dynamics before their full impact is understood. ISPOR US 2026 made it clear: Europe is no longer the second act in global launch strategy. Under MFN, IRP, JCA, AMNOG and increasing payer pressure, it is a defining force of global value.

For US companies, this shifts the priority from sequencing decisions to strategic design: aligning evidence, pricing, and launch planning early, before the first European price sets the trajectory for global success.

Europe can set your US price ceiling—before you’ve even launched in the US. If you’re planning a European launch (or rethinking sequencing under MFN/IRP pressures), let’s stress‑test your evidence, pricing and launch order now—so early EU decisions protect global value rather than quietly erode it.