For more than two decades, the dominant paradigm for explaining pharmaceutical pricing has been value. That value was defined by clinical benefit, improved patient outcomes or experience, and the longer-term societal return of reducing disease burden. While value itself has not had a singular definition, it did provide a framework that shaped how therapies were launched, reimbursed, and defended — particularly for specialty and biologic medicines — and it gave companies a consistent story to tell regulators, payers, prescribers, and patients. 

 

Today, that clarity is gone with more recent policy and market shifts. It’s not just that pricing strategies are changing. Explaining price and linking it back to a unified understanding of value has become more complicated than ever. 

 

With the rise of direct-to-patient (DTP) and direct-to-employer (DTE) models, government-set prices under the Inflation Reduction Act, and initiatives like TrumpRx and Most Favored Nations (MFN), the market now contains more visible price points than at any time in modern pharma history. These prices are often dramatically different from one another — and increasingly disconnected from traditional, U.S.-centric definitions of value. As a result, companies face a growing communications and business challenge: how to justify multiple prices, to different audiences, in a politicized environment where value is no longer the sole anchor. 

 

From Value to Visibility, and Contradictions 

Programs like TrumpRx — an evolution of the administration’s MFN drug pricing approach — exemplify this shift. Rather than tying price to clinical or societal value, TrumpRx benchmarks certain drug prices to what other developed countries pay, informed by health technology assessment approaches with different priorities and conceptions of value. At the same time, Medicare price setting under the Inflation Reduction Act, alongside expanding DTP and DTE offerings, is introducing highly visible, often substantially lower prices into the market. 

 

The result is not a single new pricing paradigm, but a fragmented landscape of co-existing prices: 

• Traditional list prices 

• Insurance-negotiated prices 

• Government-set prices 

• International reference prices 

• Cash-pay or direct-to-consumer prices 

 

These prices may be rational within their individual policy or channel mechanics — but to patients and other stakeholders, they can appear arbitrary, contradictory, or even unfair. 

 

The New Risk: Confusion, Erosion of Trust, and Narrative Breakdown 

As pricing becomes more transparent, the challenge is no longer simply defending a price — it is defending the existence of different prices at all. 

 

Patients may struggle to understand why they are quoted one price while seeing another advertised publicly. Employers and policymakers may question why lower prices are available in some channels or for some products, but not others. Even when alternative prices apply to limited populations or are constrained by policy design, their visibility can undermine credibility and fuel skepticism. 

 

In this environment, the traditional value-based narrative — while still essential — is no longer sufficient on its own. Value may explain why a medicine matters, but it no longer fully explains pricing across every channel. 

 

What Comes Next: Reframing How Price Is Explained 

For life sciences companies, payers, and healthcare stakeholders, the implications are clear. Success in this next era will depend not only on pricing strategy, but on how pricing is explained, contextualized, and communicated. That means: 

 

• Assessing the risks and benefits of emerging pricing and access models — including MFN-style pricing, DTP and DTE offerings, cash-pay options, and government-set prices — and understanding how each reshapes expectations around affordability, equity, and innovation. 

• Mapping audience perceptions across a fragmented landscape, recognizing that patients, employers, policymakers, prescribers, and advocates may each encounter different prices — and may define “value” through very different lenses. 

• Developing a clear, cohesive communication framework that connects differentiated prices to a unified value story — transparently explaining why multiple prices exist, how policy and channel mechanics shape them, and where clinical benefit, outcomes, and societal value still play a role. 

• Identifying strategic opportunity amid disruption. While multiple prices can invite scrutiny, they also create new ways to engage stakeholders directly, demonstrate responsiveness to affordability concerns, educate on policy realities, and reinforce credibility around access and patient-centered decision-making. 

 

In a multi-price world, silence or reliance on legacy value arguments risks confusion — or worse, loss of trust. Organizations that plan now — and proactively define how they will talk about price, value, and access in a fragmented market — will be far better positioned to navigate what comes next.