Postscripts Rx
Conversations Beyond the Prescription. Where pharma, HCPs, life science and digital health solutions meets patients—after the script is written. Conversations on digital health, engagement, and real-world impacts that are re-writing the future of patient engagement.
Postscripts Rx
Made in America: Eli Lilly's $6.5B Texas Spend
Pharmaceutical giants are bringing manufacturing back to American soil in a massive strategic pivot. Eli Lilly's recent $6.5 billion investment in a Texas facility for its obesity medications signals a transformative shift that's rapidly spreading throughout the industry, with Pfizer, Amgen, and Novo Nordisk collectively announcing over $20 billion in domestic manufacturing projects.
This reshoring revolution isn't happening by chance. The Biden administration's Most Favored Nation pricing framework aims to align U.S. drug prices with those in other developed countries, fundamentally disrupting the traditional premium pricing model that has made America the profit center for global pharmaceutical sales. With the U.S. representing 41% of the global pharma market value but just 4% of world population, companies are scrambling to maintain profitability as pricing power diminishes.
Manufacturing domestically offers multiple strategic advantages beyond mere publicity. It provides greater control over production costs, accelerates speed to market, reduces regulatory delays, and addresses the supply chain vulnerabilities painfully exposed during the COVID-19 pandemic. The administration has sweetened the deal by promising expedited FDA and EPA approvals for new pharmaceutical facilities and potentially offering flexibility on MFN enforcement for companies making significant U.S. investments.
Digital health platforms are emerging as crucial components in this new landscape. Solutions that improve medication adherence, provide real-world data, and demonstrate measurable outcomes offer pharmaceutical companies powerful tools for negotiating with payers and justifying their pricing strategies. With improvements in adherence reaching up to 34%, these technologies directly support better patient outcomes while potentially reducing overall healthcare costs.
This manufacturing migration affects every department within pharmaceutical organizations. Brand teams must rethink product roadmaps to prioritize therapies with U.S.-aligned supply chains. Patient access groups need to integrate digital companions into their support programs. Procurement must accelerate domestic partner vetting, while IT departments ensure compliance with U.S. regulatory frameworks like HIPAA.
What's your organization doing to adapt to this new reality where domestic manufacturing and digital innovation are becoming critical to pharma success? Subscribe to Postscripts for more insights at the intersection of pharmaceutical strategy, technology, and patient impact.
Sources:
- CNBC: “Eli Lilly plans $6.5 billion Texas manufacturing plant for obesity pill” (2025-09-23)
- IQVIA Institute for Human Data Science: “The Global Use of Medicine in 2023 and Outlook to 2027”
- Medisafe internal outcomes data, 2023
- Health Affairs: "Implications of Most Favored Nation Drug Pricing Proposal" (2022)
PostScripts Rx is not intended to constitute medical advice, nor is it intended to influence prescribing decisions or any other medical or clinical decision-making. All medical and clinical judgment and decision-making, prescribing decisions, and all related considerations remain exclusively the responsibility of providers and patients.
Welcome to Postscripts, the podcast exploring what happens after that first prescription. We cover the latest innovations in patient access support, digital tools, HCP engagement and the pharma marketing that we all hope drive better outcomes for patients. This podcast is for informational purposes only, does not constitute any medical advice, nor should it be used for to influence any clinical decision-making. Patients should always consult their healthcare professionals. Welcome to the podcast. My name is Brian Carr. I'm from the Medisafe team, although any opinions expressed here are my own and not necessarily those of Medisafe or its partners. Today we have a big one here. Why are pharma investments booming in the US right now? We're focusing on a major trend with enormous implications right now for pharma marketers, brand execs, patient access professionals and C-suite decision makers. There's a significant migration of pharma investment back to the US soil. It's a trend driven in part by policy changes, access challenges with supply chain and, of course, pricing pressures that are coming from Washington. But one of the starkest examples happened just yesterday when this shift came when Eli Lilly announced a $6.5 billion investment in a new Texas facility to manufacture its booming obesity drug portfolio, including much-anticipated oral version not injectable of its hit GLP-1 medication. So, according to CNBC, this new manufacturing plant will eventually create over 1,500 jobs, become one of the largest capital projects in the company's history. And the US administration this summer had already signaled that they will fast-track the development of new plants in the United States through the FDA and EPA improvements process. Because pharma companies had said, hey, listen, we'd love to build plants in the US but it takes five to 10 years to get them online. The administration in its executive order had said that it would work to expedite those approvals from the FDA and the EPA, in fact move those projects perhaps to the front of the line for approval. So you know why is this suddenly happening.
Speaker 1:Well, you've seen this most favored nation pricing paradigm shift for pharma companies that came in this summer where the US administration said that they want to align US drug prices with those paid in other advanced nations. So under an MFN model, most favored nation Medicare reimbursement, in particular for certain drugs, would be capped to the lowest price paid among these developed countries. That may sound really fair to consumers, but the challenge there for pharmaceutical companies is a global pricing challenge. Right, the US is traditionally the premium priced market. A global pricing challenge right, the US is traditionally the premium priced market. It forms the bulk of global revenues and margins for many blockbuster therapies, so those prices begin to shrink. It kind of forces that fundamental re-evaluation of global commercial strategy and prices outside of the US. So, according to IQVIA for example, the US accounts for nearly 41% of the global pharma market by value, but only about 4% of the world's population right. So the average cost of a standard treatment course in the US essentially loses its premium pricing status unless pharma manufacturers can change the equation on the cost side, right. So that's where domestic manufacturing becomes a business imperative, not just a nice-to-have but a must-have. Right.
Speaker 1:The strategic return to the US manufacturing, and here's why what you're seeing historically offshore pharma manufacturing made more sense here. Right Outside of the US you could have lower labor costs, lighter regulatory engagement, proximity to global raw materials right. All to reduce the couple of things here, covid-19. You may recall the COVID-19 really did expose the supply chain fragility, not only for, for example, auto parts and computer parts and batteries and things like that, but also exposed it in the pharma raw materials verticals as well. So exposed that risk of dependence on international suppliers, geopolitical tensions causing regulatory bottlenecks and disruption in trade flows those are only growing. And now there's public pressure on pharma companies to really bring jobs and investment back home here to the US. So now you're seeing companies like Eli Lilly are quote reshoring not only to smooth distribution and regulatory delays, but they're also doing it to control production costs in a world where pricing power really has shifted dramatically. So let's go back to Lilly's $6.5 billion Texas plan. The CEO of Lilly, david Rick, said it's faster speed to market, us cost control, proximity to patients and launching this new GLP-1-related therapy as primary drivers for the strategic shift. But an equally fundamental motivation lies in this MFN rule alignment Company needs to optimize the cost and then maintain competitiveness under better care reimbursement rate changes.
Speaker 1:So this new equation of quality access policy compliance it's pivot. It isn't just about moving factories, it's about adjusting business models to fit a new economic reality, a reality in which access quality policy compliance they're becoming key differentiators when you see compressed margins. So, for example, these pharma company decisions now involve really balancing innovation with manufacturing agility right. So as development timelines can shrink and launch success becomes more data-driven. Proximity to supply becomes a source of speed and supply chain safety. You're also seeing cost parity across those global markets. Us prices are now being tethered to these foreign benchmarks, requiring that end-to-end operational efficiency across the board for pharma companies to maintain profitability. Domestic contract sourcing and security, from ingredient sourcing to packaging and pharma sourcing must really meet those new cybersecurity and FDA traceability standards. So, again, this has profound impact for pharma teams, from procurement to brand strategy, commercial operations, digital marketers.
Speaker 1:Everyone must now ask how do we align our therapeutic strategy with the evolving pricing, competition standards, manufacturing and access? Right, so you look at digital companions like Medisafe and others. It's a hidden lever in the manufacturing pivot because pharma companies are navigating this MFN-aligned economics and they bring more production to the US. It really does force that renewed. Look at all the drivers of cost efficiency and therapeutic values and market preservation, market share preservation, una and I might call that persistence and compliance on therapy Business folks may refer to that as are we retaining our market share of those patients that we've successfully enrolled in the medication of the program. Right, so that's where digital medication management tools really do help patients stay on track with these complex drug regimen and really provide actionable insights, survey data, actual real-world data on a pharma medication to be taken on time or not. Right? So pharma has access now to some of that real-world data and it can reduce churn and enable better documentation for the payer negotiations right, because digital companions can improve adherence by we've seen it up to 34%. So I mean we see that better adherence leaving you improved outcomes, ie patients on therapy, fewer visits to emergency rooms, et cetera. We know all that data. That means less overall cost impact, getting some of the payers and other partners in the systems right, so it can translate to stronger coverage positions, especially if you're looking at that value-based care model that is really influenced by MFN rules. So, as you see, these drugs like obesity, targeting GLP-1s, the flooding market differentiators aren't just going to be on efficiency and safety. It will be the value support ecosystem and digital tools are really core to that model to really prove and get the independent third-party data to the partner and the commercial teams that need it for their MFN pricing justifications elsewhere. So the strategic implications of the shift really do ripple across the departments. Here's where each team must start thinking about in light of both MFN pricing pressure and the manufacturing shift.
Speaker 1:Look at the brand and innovation teams. They're going to be rethinking product roadmaps, prioritizing therapies with all these US-aligned supply chains. They're going to be investing in launch excellence platforms that integrate US-specific regulatory and access data. Then you look at patient access and support teams. They're going to be aligning access programs with domestic production timelines and they can be considered digital companions to enforce those engagement metrics. Look at the procurement and manufacturing teams at Pharma. They're going to want to accelerate domestic partner vetting and vendor readiness scenarios, especially for tech, integrated packaging and serialization compliance with the FDA rules. They're going to develop flexible sourcing models that accommodate value-based contracting opportunities under the MFN rules. Look at the IT and even cybersecurity teams at Pharma, reinforcing data integrity systems with these domestic partners here in the US, as international data lakes may conflict with health and human services compliance frameworks. They're going to want to ensure all the digital pharma tools used, including patient-facing apps, are interoperable with US systems under HIPAA and ONC guidelines, right.
Speaker 1:And then, finally, look at the C-suite strategy teams. Right, they need to create investment blueprints tied directly to US pricing dynamics, doubling down on outcome-based pricing models tied to local manufacturing agility, patient engagement benchmarks. So are more companies going to follow Lilly's footsteps? Well, it's a resounding yes. So far, you've got Pfizer, amgen, novo Nordisk. They've all announced US capital projects over $20 billion in the past few months, and that's no coincidence, the pharma leaders are really recognizing that building in America isn't just PR, it's a strategic response where future pricing and access conversations are heading heading. So when you have that MFN pricing and increasing digital oversight, value must be proven, not promised, though, and to do that Pharma really needs to integrate manufacturing tech, domestic patient support, into unified strategies that really focus on access and affordability. So, in conclusion, pharma's future, you know once again, is made in America.
Speaker 1:You even saw in the US administration's executive order that came out this summer that one of the fourth bullet points wasn't really reported that much, but it really showed how important it is that MFN pricing may be lifted a bit, or not necessarily as impactful if the pharma companies are manufacturing and going direct to consumer in the US, right. So that came from pharma discussion with the administration prior to the executive order, where they said we'd love to have lower prices in the US, but if we could, when we could do it overnight, if we just go direct to consumer, cut out a lot of the middlemen and women in the system and really go direct to consumers. You actually saw that carve out in the executive order back in May as a fourth bullet point or so, that said, MFN status may or may not apply to those going direct to consumer. It was the administration's recognition that if you're investing you may get, let's just say, a break on your MFN enforcement right. So you know, I know these mega projects really do symbolize a broader realization across the industry.
Speaker 1:The path to future competitiveness really does run through operation agility, us domestic investment and patient-centric technologies. Digital platforms are going to play a critical role in this next phase of value building because they offer measurable proof of impact that really does align with the demands of CMS payers and patients alike. So, as you see, brand access, procurement, innovation leaders they really know it's time to act. They're aligning their pipelines, people and partnerships to this shifting operational landscape. It's no longer optional, really is becoming a must-have, not a nice-to-have. So thank you for joining us on Postscripts. If you found this conversation valuable, please follow or subscribe for more insights at the intersection of pharma tech patient impact. Until next time, keep looking forward that real work begins after the script is written.
