What Australia will pay for a year of life is now a number other systems reference.
The United States now prices some of its medicines against other countries, and which of its instruments reference Australia depends on the basket: in the nineteen the Medicare models would use, out of the eight the Medicaid model uses. This page states the baskets, reads the Australian record for what it actually shows, which is a file of decisions with the cost per year of healthy life stated in a minority of them and redacted in most, and counts how much of that record belongs to the firms that have signed a US deal.
Three instruments, three baskets
A medicine can be inside one basket and outside another. Australia is in the nineteen that GLOBE references (final, from April 2027) and GUARD would reference, and is not one of the eight that GENEROUS references. Saying "Australia is in the basket" as one fact is a mistake this page exists to stop. The second distinction matters as much for Australia: GENEROUS references net prices, and the Medicare models default to list prices. Australia's list price is public and its net price is not.
| Instrument | Programme | Status | Basket | Australia | Benchmark |
|---|---|---|---|---|---|
| GENEROUS | Medicaid | Voluntary; a five-year model dated from 1 January 2026. As at September 2026 it is still being set up and the sign-up deadlines have been pushed back (NPR). On 18 September 2026 the White House announced MFN pricing extended to every state Medicaid programme for the 26 signatories. Participants are exempt from GLOBE: the waiver is now written into the GLOBE final rule | Eight: UK, France, Italy, Germany, Canada, Japan, Switzerland, Denmark | out | Second-lowest net price the manufacturer reports, adjusted for GDP per head at purchasing power parity |
| GLOBE | Medicare Part B | Final. Rule issued 30 September 2026, published 2 October; effective 30 November 2026. Data collection from 1 January 2027; performance years 1 April 2027 to 31 March 2032. Mandatory, but narrowed: single-source Part B drugs above $100 million a year in seven categories, with orphan-only drugs, cell and gene therapies, plasma-derived products and drugs with a negotiated maximum fair price excluded, and GENEROUS participants waived. Projected savings cut to $440 million; Sidley expects about four manufacturers to be in it | Nineteen OECD markets | in | The greater of two figures: the lowest list price in the nineteen that CMS can find, and, if the manufacturer volunteers its net prices, the average of those. Both adjusted for GDP per head at purchasing power parity. Volunteering net data can only raise the benchmark |
| GUARD | Medicare Part D | Still proposed (23 December 2025); mandatory if finalised; proposed from January 2027. No final rule as at 7 October 2026 | The same nineteen | in | As GLOBE |
| Voluntary deals | All channels, by company | 26 manufacturers, "89% of the branded drug market" (White House), as at 31 August 2026. The agreements are unpublished; asked by NPR, none of the first seventeen would confirm that all of its medicines would be discounted | "Comparable developed nations": not a published list | unstated | Deal terms, not a public formula |
Status as at 7 October 2026. This table is the one hand-maintained part of the page and is rewritten when an instrument moves. The consequence of the exemption, now in the GLOBE final rule, for Australia: the instruments that reference an Australian price are the ones a GENEROUS participant sits outside. GLOBE is final, and the 26 signatories can opt out of it by participating in GENEROUS; the firms left in scope are few. This page does not follow the day-to-day of US policy; it reads the Australian side.
The baskets
Each country the US instruments reference, drawn as itself, one row per instrument class, west to east within the row; the shapes are not to a common scale. A different committee, a different population and a different price in every tile, so this is a map of who is in which basket and nothing else; tap, hover or tab to a tile for the pricing mechanism and whether its public price is a list price or a net one.
Tap, hover or tab to a tile: its basket, its pricing mechanism, and whether the public price is a list price or a net one.
The list-or-net distinction is most of the story: the eight are referenced on net prices that sponsors report; the nineteen on the prices available to CMS, and Australia's effective prices sit behind special pricing arrangements nobody publishes.
Every referenced market, and how its price is made
| Market | Eight | Nineteen | Pricing mechanism | Public price is | Note |
|---|---|---|---|---|---|
| Canada | yes | yes | PMPRB ceilings, pCPA negotiation, CDA review | list public; pCPA net hidden | In both baskets; sector task force since March 2026 |
| Denmark | yes | yes | Medicines Council | public | In both |
| France | yes | yes | HAS, CEPS negotiation | list public; rebates hidden | In both |
| Germany | yes | yes | AMNOG negotiated price after year one | negotiated, public | In both |
| Italy | yes | yes | AIFA negotiation | list public; rebates hidden | In both |
| Japan | yes | yes | NHI price list, biennial cuts | public | In both |
| Switzerland | yes | yes | FOPH price, external reference | public | In both |
| United Kingdom | yes | yes | NICE threshold, VPAG clawback | list public; VPAG rebate | In both |
| Australia | — | yes | PBAC, PBS, special pricing arrangements | list (DPMQ) public; effective hidden | In the nineteen, out of the eight |
| Austria | — | yes | HVB reimbursement code | public | Nineteen only |
| Belgium | — | yes | CTG-CRM | list public | Nineteen only |
| Czech Republic | — | yes | SUKL | public | Nineteen only |
| Ireland | — | yes | NCPE, HSE negotiation | list public; rebates hidden | Nineteen only |
| Israel | — | yes | health basket committee | public | Nineteen only |
| Netherlands | — | yes | ZIN, sluice negotiation | list public; net hidden | Nineteen only |
| Norway | — | yes | national list | public | Nineteen only |
| South Korea | — | yes | HIRA, NHIS negotiation | public | Nineteen only |
| Spain | — | yes | CIPM, national | list public | Nineteen only |
| Sweden | — | yes | TLV value-based pricing | public | Nineteen only |
| New Zealand | — | — | PHARMAC budget tender | public | Not referenced by any US instrument |
A different committee, a different population and a different price in every row. This is a map of mechanisms, not a league table, and it deliberately carries no prices and no thresholds.
The barometer: Australia's price for a year of life
The PBAC does not publish a threshold. It publishes decisions, and each Public Summary Document states, or redacts, the cost per quality-adjusted life year the sponsor asked the committee to accept. Counted across every decision since 2015, band by band, the record shows how often the committee said yes at each stated figure, and how few decisions state one at all.
One honesty line before the chart. This is not the price MFN imports. The US instruments reference a country's list or net price for a medicine; the bands below are a stated dollars-per-QALY figure, often a threshold-seeking ask, and the effective Australian price sits behind special pricing arrangements the public does not see. The chart shows what the committee has been willing to accept. It cannot name the price anyone is paying.
What this is not: a threshold the committee has ever stated, or a price. It is the pattern of what it accepted, at the cost per QALY sponsors were willing to put in writing. A redacted ICER is a decision made at a price the public cannot see, and the share of those is the number to watch each cycle.
What the Australian record shows
Australia is the country the instrument table is about: referenced by the mandatory Medicare models, not by the voluntary Medicaid one. Its public price is not its real price, so the honest sentence is this: we do not see net special-pricing-arrangement prices, and cannot say what price MFN would import from Australia. What we can see is the committee's behaviour and what happens after a yes.
One year of higher deferrals is consistent with MFN and also with a committee asking for more evidence. The number that would settle it is time from recommendation to listing, below.
From recommendation to listing: signatories and everyone else
If MFN were holding Australian listings back, it should show first in the firms that signed a US deal: their recommendations would list more slowly, or be abandoned more often, than everyone else's. So far they don't. Recommendations from the 2025 meetings listed more slowly for every sponsor, which points to the process rather than to MFN. Since the deals began, signatories' recommendations have listed faster within six months, not slower.
| PBAC meetings | Sponsor | Listed within 6 months | Within 12 months |
|---|---|---|---|
| Before the executive orderto March 2025 | MFN signatories | 44% (155 of 355) | 73% (259 of 355) |
| Before the executive orderto March 2025 | Other sponsors | 43% (128 of 300) | 71% (212 of 300) |
| Order to first dealsMay to September 2025 | MFN signatories | 31% (4 of 13) | 69% (9 of 13) |
| Order to first dealsMay to September 2025 | Other sponsors | 38% (9 of 24) | 71% (17 of 24) |
| Deal eraNovember 2025 onward | MFN signatories | 44% (18 of 41) | too recent |
| Deal eraNovember 2025 onward | Other sponsors | 31% (10 of 32) | too recent |
PBS Medicine Status register as at 1 October 2026; positive recommendations from July 2019 (799), one record per submission. A meeting enters a column only once it has that much follow-up, so recent meetings are not counted as slow for being recent. Recommendations later ceased by the sponsor: 12 signatory, 11 other. Signatories are the 26 firms with a US deal, matched on the Australian sponsor name. The periods after the order are small, and this is an association over time, not a test of cause.
The firms that have signed, in the Australian record
The US obligations attach to firms: the White House fact sheets name Medicaid prices, TrumpRx, and most-favoured-nation pricing on new medicines, and the agreements themselves are unpublished. If a firm were to change how it launches in Australia because of them, it would show here first, as fewer submissions, more withdrawals, or recommendations left unlisted. 26 manufacturers have signed. This is how much of the Australian record is theirs.
No change can be read from this yet. 2025 is the lowest full year in the series at 52%, against 55% to 68% in the years before it, and almost all submissions to 2025 meetings were lodged before the first deal was signed. The share moved by as much between earlier years, before MFN existed. The count is here so that it can be read again each cycle, not because it has found something.
| Manufacturer | Signed | Documents since 2020 | Recommended, not yet listed | On the next agenda |
|---|---|---|---|---|
| AbbVie | by April 2026 | 31 | 5 | 1 |
| Amgen | by April 2026 | 23 | 9 | — |
| AstraZeneca | by April 2026 | 74 | 8 | 2 |
| Boehringer Ingelheim | by April 2026 | 12 | — | 2 |
| Bristol Myers Squibb | by April 2026 | 41 | 5 | — |
| Eli Lilly | by April 2026 | 23 | 7 | — |
| EMD Serono (Merck KGaA) | by April 2026 | 11 | 2 | — |
| Genentech (Roche) | by April 2026 | 26 | 1 | — |
| Gilead | by April 2026 | 12 | 3 | — |
| GSK | by April 2026 | 30 | 8 | — |
| Johnson & Johnson | by April 2026 | 38 | 12 | — |
| Merck & Co (MSD) | by April 2026 | 36 | 4 | 1 |
| Novartis | by April 2026 | 51 | 8 | — |
| Novo Nordisk | by April 2026 | 9 | 4 | — |
| Pfizer | by April 2026 | 42 | 7 | — |
| Regeneron | by April 2026 | — | — | — |
| Sanofi | by April 2026 | 27 | 7 | — |
| Alcon | 31 August 2026 | 4 | 1 | — |
| Astellas | 31 August 2026 | 15 | 5 | 1 |
| BeOne Medicines | 31 August 2026 | 8 | 1 | — |
| BridgeBio | 31 August 2026 | — | — | — |
| CSL | 31 August 2026 | 17 | — | — |
| Kyowa Kirin | 31 August 2026 | 6 | 1 | — |
| Sun Pharma | 31 August 2026 | 10 | 2 | — |
| Teva | 31 August 2026 | 11 | 3 | — |
| UCB | 31 August 2026 | 13 | 3 | — |
In signing order, then alphabetical: a register, not a ranking. Counts are by the Australian sponsor of record, mapped to today's parent: Alexion to AstraZeneca, Celgene to Bristol Myers Squibb, Allergan to AbbVie, Seqirus and Vifor to CSL, BeiGene to BeOne, ViiV to GSK. Sandoz is not counted with Novartis. A signatory whose medicines are sponsored here by a partner or a distributor shows a dash: Regeneron and BridgeBio have no Australian sponsor of record, and BridgeBio's acoramidis is on the November 2026 agenda under its distributor. A jointly sponsored submission counts once for each firm and once in the totals. The first seventeen are the recipients of the July 2025 pricing letters; the nine are named in the White House fact sheet of 31 August 2026.
What this page is not
Not a price league table, not a daily wire, not a ranking of firms, not medical advice, and not a trading note. A first-pass event study of PBAC outcomes against share prices, with approximate event dates, found nothing consistent in mid or large caps (mean abnormal return +1.9% and −0.1%, hit rates near a coin toss); the small caps, where a move would matter, were not priced. What moves is policy, and the instrument table above is the policy. The global read belongs to the people who do it daily; we hold the Australian file.
script.report provides factual analysis of public documents and general information about reimbursement policy. It does not provide financial product advice, does not hold an Australian Financial Services Licence, and nothing here is a recommendation to buy or sell any security.
Sources
- CMS Innovation Center: the GENEROUS model (primary)
- CMS, 30 September 2026: GLOBE model final rule announced (primary)
- Sidley, October 2026: GLOBE significantly narrowed in the final rule (explainer)
- White House, 18 September 2026: MFN pricing extended to every Medicaid programme (primary)
- Federal Register, 23 December 2025: GLOBE model proposed rule (primary)
- Federal Register, 23 December 2025: GUARD model proposed rule (primary)
- CMS Innovation Center: the GLOBE model (primary)
- White House, 31 August 2026: nine more manufacturers, 26 in all (primary)
- Endpoints News, September 2026: internal CMS email on the GLOBE and GUARD exemption for GENEROUS participants
- NPR, 17 September 2026: which medicines the first seventeen firms will discount in Medicaid
- Gibson Dunn, September 2026: the nine new signatories; GLOBE and GUARD under OMB review (explainer)
- Sidley on GENEROUS (explainer)
- Reed Smith on GLOBE and GUARD (explainer)
One question
The instrument table, the grid and the firm counts are free and will stay that way. If MFN has put a specific Australian question on your desk, send one research question and it comes back referenced to the documents, or register for the cycle briefing.