'Trump’s MFN Pricing Expected To Delay More European Drug Launches'

 

Following Insmed’s decision to hold off on launching a newly approved lung disease drug in Europe, experts anticipate more companies will do the same as they seek to avoid price erosion in the U.S. Will Chinese biotechs fill the void?

Despite receiving European approval for inflammatory lung disease drug Brinsupri last November, Insmed is holding off on launching the product due to lingering questions around President Donald Trump’s Most Favored Nation drug pricing initiative. The company is far from the only biopharma reevaluating their global launch strategies in light of MFN. As the far-reaching effects of the policy unfold, experts warn that retreating from overseas markets could have unintended consequences—including providing a springboard for Chinese biotechs.

In addition to Insmed, Ligand Pharmaceuticals, United Therapeutics and multiple other companies have discussed how MFN is shaping their ex-U.S. strategies. Many other drugmakers are evaluating their strategies in private. Matthew Majewski, vice president at Charles River Associates (CRA), told BioSpace that companies working in various therapeutic areas have asked his team whether they should be launching in the EU and other MFN reference markets.

Companies have questioned whether they can limit launches to the markets where they can charge the most to avoid eroding U.S. prices, Majewski explained. However, that approach has a flaw. As Eva Marchese, vice president at CRA, told BioSpace, a new EU pharma regulatory package contains provisions to stop companies from cherry-picking EU countries.

Without the package, a drugmaker could limit launches to countries such as Germany. With the package, the U.S. price could be tied to the Czech Republic and Spain. A CMS assessment found Germany’s purchasing power is 83% of that of the U.S., while in the Czech Republic and Spain it is 64%.

If the Trump administration pushes ahead with its proposed MFN models, drugmakers will need to either accept lower prices in the U.S., persuade reference countries in the EU and other regions to pay more or restrict where they launch medicines. Majewski described the situation as a “game of chicken.” Unless someone backs down, Majewski said some drugs might not reach the EU in “the short-ish term.”

Nerea Blanqué-Catalina, a partner in global market access, pricing and sustainability at Alira Health, agreed, even going so far as to suggest that drug availability in the U.S. and Europe could diverge to the extent that there are effectively two different standards of care.

The situation has led experts to start considering what happens if companies avoid launching drugs in Europe or set high prices that severely limit uptake. One possibility is that Chinese biotechs will fill the gap.

Filling the Void

Typically, multiple companies are developing molecules for every major drug target. If one company decides against launching in the EU, a rival that is less price-sensitive could quickly introduce a molecule with the same mechanism of action.

Allistair Booth, a partner at Pinsent Masons, told BioSpace via email that Chinese biotechs “are very well placed to take advantage of any market anomalies MFN creates.” Booth estimated that the cost of drug development in China may be low enough to enable commercially viable returns on ex-U.S. products.

Majewski said biopharma companies are “saber-rattling” about the threat of Chinese biotechs claiming markets abandoned by U.S.-focused drugmakers over MFN concerns. Yet he agrees that companies from China, Europe or other regions could step up if new drug launches are restricted to the U.S.

The consequences of rivals claiming overseas markets could come back to the U.S. market. If a company can set a price that is acceptable to EU payers, Majewski sees no barrier to them bringing the product to the U.S. and undercutting companies that have avoided MFN reference markets. Citing that scenario, Majewski predicted that companies with drugs that can be copied will conclude that they need to launch in the EU despite MFN dictating that U.S. prices must drop as a result.

For now, though, experts who spoke with BioSpace maintain that, in the near term, a U.S.-only strategy is likely to win out. Blanqué-Catalina foresees MFN limiting which drugs launch in the EU for at least the next five years.

Concern about reputational risk could slow the divergence, as drugmakers headquartered in Europe would feel “very weird” to only launch a medicine in the U.S., Marchese said. However, such pressures only apply to a subset of the top global drugmakers. Majewski agreed that for now, European patients will miss out on novel therapeutics.

“U.S. prices need to come down, and European prices need to come up a little bit in order to meet this happy medium. There could be some pain while we play this game,” Majewski said. “Long term, there’s hope for the future that we’ll figure it out.”

https://www.biospace.com/business/trumps-mfn-pricing-expected-to-delay-more-european-drug-launches

United Arab Emirates ready to help US open Strait of Hormuz by force: WSJ

 The United Arab Emirates is reportedly preparing to help the US fight Iran and open the Strait of Hormuz by force after being repeatedly struck by Iranian drones and missiles since the war began, Arab officials said.

The UAE is lobbying the United Nations Security Council to pass a resolution that would authorize a military operation to end Iran’s grip on the critical trade route, officials told the Wall Street Journal.

The operation would see the UAE become the first Persian Gulf country to join the war against Iran, with Abu Dhabi calling on European and Asian military powers to join the coalition to open the strait.

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Cargo ships in the Gulf, near the Strait of Hormuz, as seen from northern Ras al-Khaimah, near the border with Oman’s Musandam governance, amid the U.S.-Israeli conflict with Iran, in the United Arab Emirates, March 11, 2026.REUTERS

Along with opening the Strait of Hormuz, the UAE is also calling for the US to occupy strategic islands near the oil-critical Strait of Hormuz, including Abu Musa, which Abu Dhabi claims but is currently held by Iran, officials said.

Bahrain, a close US ally in the region that hosts America’s Fifth Fleet, is sponsoring the UN resolutions, with a vote expected on Thursday, according to the WSJ.

Russia and China, allies of Iran who sit on the UN’s Security Council, would veto the resolution.

Nations in the Gulf, Europe and Asia have all called for the Strait of Hormuz to be opened as it serves as a key pipeline for 20% of the world’s oil supply.

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The Indian-flagged carrier Jag Vasant, carrying liquefied petroleum gas (LPG) via the Strait of Hormuz, arrives at Mumbai Port in Mumbai, India, 01 April 2026.DIVYAKANT SOLANKI/EPA/Shutterstock

Iran effectively closed the Strait to anyone it deems its enemies after the US and Israel waged war on the Islamic Republic.

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Tehran approved a bill on Tuesday to charge a toll to all ships passing through the strait, demanding up to $2 million per vessel.

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The Dubai skyline with the landmark Burj Khalifa skyscraper (R) is pictured as a smoke plume rises from an ongoing fire near Dubai International Airport on March 16, 2026.AFP via Getty Images

President Trump has repeatedly ordered Iran to open the waterway after oil prices surged, with the US calling on its allies to help open the strait by force.

Other countries, however, have hesitated to commit their militaries to open the waterways given the threats from Iranian mines and drones.

The UAE, which has been vocal against Iran and its closure of the Strait of Hormuz, has seen attacks from Tehran soar in recent days after the Gulf state signaled its willingness to join the war.

Iran fired nearly 50 ballistic missiles, cruise missiles, and drones against the UAE on Tuesday alone, leaving at least four people injured after debris fell on their Dubai home following an interception.

Repeated attacks near the Dubai International Airport, one of the world’s busiest transportation hubs, have also led to reduced air traffic and tourism to the UAE.  

https://nypost.com/2026/04/01/world-news/uae-ready-to-help-us-open-strait-of-hormuz-by-force-report/

Pentagon doubling A-10 fleet in Middle East - NYT

 The Pentagon is doubling its fleet of US Air Force A-10 attack aircraft in the Middle East, the New York Times reported on Wednesday, citing two Pentagon officials.

The report said the Air Force is sending 18 A-10s to join roughly a dozen already in the region, which US commanders have used to strike Iranian boats and Iran-backed militias in Iraq.

https://www.iranintl.com/en/liveblog/202604015564#202604017176

Ex-president calls for reforms, says Iran should prepare honorable end to war

 Former President Hassan Rouhani called for reforms in policymaking and said Iran should prepare for an honorable end to the war, while continuing resistance.

“Alongside heroic resistance, we must be prepared to bring the war to an honorable end in the interest of the country and the people,” he said.

Addressing the Supreme National Security Council, he said it should urgently place different scenarios for continuing or ending the war into the legal decision-making process.

“Preserving the country and the system requires immediate fundamental reforms in policymaking; the people have made their position clear to the authorities,” he said.

Rouhani also said it was necessary to coordinate national resources to prevent attacks on the Persian Gulf islands and maintain control of the Strait of Hormuz.

https://www.iranintl.com/en/liveblog/202604015564#202604017176

Trump campaign against Iran regime 'clear and unchanging', White House says

 US President Donald Trump’s objectives in the campaign against the Iranian regime remain “clear and unchanging” while driving decisive progress, the White House said on Wednesday.

Trump will address the nation on Wednesday night on Operation Epic Fury, “a decisive campaign of American strength that is systematically dismantling the Iranian regime’s ability to threaten the United States and the free world," according to the White House.

In a statement, the White House said the operation aimed to destroy Iran’s ballistic missile arsenal and production capacity, weaken its naval forces, cut support for allied groups, and prevent it from acquiring a nuclear weapon.

It said the campaign was being carried out with “unmatched power and precision” under Trump’s leadership.

https://www.iranintl.com/en/liveblog/202604015564#202604014355

UAE, Saudi Arabia report incoming Iranian missiles and drones

The United Arab Emirates and Saudi Arabia say their air defence systems have intercepted Iranian missiles and drones.

The UAE defence ministry said its air defences are “currently responding to incoming missile and drone threats from Iran,” adding that the sounds heard in the sky were the result of interceptions by defence systems.

Saudi Arabia’s defence ministry said its air defence systems intercepted and destroyed a ballistic missile headed toward the kingdom’s Eastern Province.

https://www.iranintl.com/en/liveblog/202604015564#202604028597

Iran war will continue until rights secured, military adviser says

 Mohsen Rezaei, a military adviser to Iran's Supreme Leader Mojtaba Khamenei, said Iran would not stop the war until it secures what he described as its rights and deters its enemies.

“Until we make the enemy regret and obtain our definite rights, we will not let it go,” the former Revolutionary Guards commander said.

He added that the end of the war depended on the supreme leader and the Iranian people and warned the United States against assuming it could act and then leave the region without consequences.

Rezaei also questioned the idea of negotiations or a ceasefire, saying: “What does it mean to talk about negotiations and a ceasefire in these conditions?”

https://www.iranintl.com/en/liveblog/202604015564#202604017078

'Leaked IRGC manual shows systematic use of civilian sites as missile cover'

 A leaked internal directive from the IRGC’s missile command appears to show that the use of civilian locations to conceal, support and in some cases facilitate missile launch operations is not ad hoc, but structured, documented and built into operational planning.

The 33-page document shared with Iran International by the hacktivist group Edalat-e Ali (Ali’s Justice) has been marked “very confidential” and is titled Instruction for Identification, Maintenance, and Use of Positions.

The document is attributed to the Specialized Documents Center of the Intelligence and Operations Deputy of the IRGC's missile command.

A framework for missile operations

What emerges from the directive is a bureaucratic framework for missile deployment that goes well beyond hardened silos or underground “missile cities.”

The text lays out categories of launch positions, inspection procedures, coding systems, site records, chains of responsibility and rules for maintaining access to a wide network of locations that can be used before, during and after missile fire.

Its significance lies not only in the variety of launch positions it defines, but in the explicit inclusion of non-military environments in that system.

In its introduction, the document says missile positions are an inseparable part of missile warfare tactics and argues that the enemy’s growing ability to detect, track and destroy missile systems requires special rules for identifying, selecting, using and maintaining such positions.

It adds that the use of “deception,” “cover” and “normalization” alongside other methods would make the force more successful in using those positions.

That language is important. It suggests the document is not merely about protecting fixed military assets. It is about making missile units harder to distinguish from their surroundings and harder to detect in the first place.

Civilian locations as missile cover

The implication of the directive is that it describes a system for embedding missile activity within ordinary civilian geography.

Rather than relying only on conventional military facilities, the document sets out a model in which missile units can move across a wider landscape of pre-identified sites selected for concealment, access and operational utility.

The result is a structure that appears designed to preserve launch capability while reducing visibility and complicating detection.

The clearest indication comes in the section on what the document describes as artificial dispersion or cover positions. These include service, industrial and sports centers, as well as sheds and warehouses – places that are civilian in function or appearance, but can be repurposed to hide missile units.

The conditions listed for such sites include being enclosed, not overlooked by surrounding buildings, and either lacking CCTV cameras or allowing them to be switched off.

Taken together, those requirements point to a deliberate screening process for civilian sites that can be used as missile cover. The concern is not only protection from attack, but invisibility within the civilian landscape.

The broader structure of the document reinforces that conclusion. It contains sections on site identities, naming and coding, inspections of routes and positions, record maintenance and responsibilities across intelligence, operations, engineering, communications, safety, health and counterintelligence.

This is the language of a standing system, not an improvised wartime workaround.

An Iranian couple walks near Iranian missiles in a park in Tehran, March 26, 2026.

A system for concealment

Farzin Nadimi, a senior defense and security analyst at the Washington Institute who reviewed the document for Iran International’s The Lead with Niusha Saremi, said the text points to a database-driven effort to identify areas around missile bases that can be used for different kinds of positions.

He said the IRGC missile force appears to have mapped not only launch positions, but also dispersal, deception and technical positions – the latter being places suitable for storing launchers and support vehicles and, when needed, preparing missiles for firing.

“These technical positions,” Nadimi said, “can include large, covered spaces such as industrial sheds or sports halls, where missile launchers and support vehicles can be brought inside, and where missiles can be mounted onto launchers, warheads attached and, in the case of liquid-fueled systems, fueling operations carried out.”

That point is critical. If civilian-looking or civilian-owned structures are being used not only to shelter launchers, but also to prepare them for launch, then the document describes more than concealment. It describes the embedding of missile operations inside civilian infrastructure.

A network built for dispersal

Nadimi also said the directive places repeated emphasis on speed – getting launch vehicles into these buildings quickly before launch and returning them to cover quickly afterward.

In his reading, the database tied to these positions includes technical features of each site, access routes and nearby facilities, including the nearest medical center, police station and military post.

It also, he added, records whether use of the property can be coordinated in advance with the owner, including contact details, or whether occupation could occur without prior coordination in urgent cases.

If so, that would suggest the system extends down to the level of property access and local civilian surroundings, turning seemingly ordinary sites into preplanned nodes in a missile network.

The document’s own emphasis on route inspection, site profiles, records and coded classification supports the picture of a missile force operating through a dispersed support architecture rather than through fixed bases alone.

Iranian missiles displayed in a park (March 26, 2026)

Why this puts civilians at risk

Nadimi warned that the use of civilian environments is especially troubling because many IRGC launchers are themselves designed to blend into civilian traffic.

“Many of these launchers essentially resemble civilian vehicles or trailers,” he said.

He added that larger launchers for Khorramshahr missiles can be covered with a white casing that makes them look like an ordinary white civilian trailer, while the towing vehicle is also typically white.

Smaller launchers, he said, are often painted not in conventional camouflage but in ways that make them less conspicuous in civilian surroundings.

That observation fits closely with the document’s emphasis on cover, concealment and post-launch disappearance. The combination of disguised launch vehicles and preidentified civilian sites suggests an operational doctrine built around blending missile units into non-military space.

According to Nadimi, this has direct consequences under the laws of war.

“The use of civilian environments, structures and buildings for this purpose is unlawful under the laws of war,” he said. “It removes the protection those buildings would otherwise have and turns them into legitimate military targets.”

The danger, he added, is that civilians living or working in such places may have no idea a missile launcher is being hidden in their vicinity until they themselves are exposed to attack.

An organized doctrine, not an exception

The leaked directive therefore appears to document something broader than the existence of underground missile facilities or dispersed launch sites.

It points to an organized method for extending missile operations into the civilian sphere – using industrial buildings, service facilities, sports complexes, warehouses and other non-military spaces as part of a launch architecture designed to survive surveillance, evade detection and preserve firing capability under wartime pressure.

In that sense, the document is not just about positions where missiles are launched from. It is about how a military force can fold launch operations into everyday civilian geography – and in doing so, transfer the risks of missile warfare onto places and people that outwardly have nothing to do with it.

https://www.iranintl.com/en/202603319302

'IRGC takes de facto control of Iran government amid deepening power struggle'

ising tensions between the Pezeshkian administration and Iran’s military leadership have pushed the president into a “complete political deadlock,” with the Revolutionary Guard effectively assuming control over key state functions, informed sources told Iran International.

The IRGC has blocked presidential appointments and decisions while erecting a security perimeter around the core of power, effectively sidelining the government from executive control.

Efforts by Masoud to appoint a new intelligence minister last Thursday collapsed under direct pressure from IRGC chief-commander Ahmad Vahidi, sources with knowledge of the situation told Iran International.

All proposed candidates, including Hossein Dehghan, were rejected. Vahidi is said to have insisted that, given wartime conditions, all critical and sensitive leadership positions must be selected and managed directly by the IRGC until further notice.

Under Iran’s political system, presidents have traditionally nominated intelligence ministers only after securing the approval of the Supreme Leader, who holds ultimate authority over key security portfolios.

However, with the condition and whereabouts of Supreme Leader Mojtaba Khamenei unclear in recent weeks, the IRGC is now effectively blocking the president from advancing its preferred candidate, further consolidating its grip over the state’s security apparatus.

Security cordon around Khamenei Jr.

Pezeshkian has repeatedly sought an urgent meeting with Mojtaba Khamenei in recent days, but all requests have gone unanswered, with no contact established.

Informed sources say a “military council” composed of senior IRGC officers now exercises full control over the core decision-making structure, enforcing a security cordon around Mojtaba Khamenei and preventing government reports on the country’s situation from reaching him.

Speculation has also emerged regarding whether Mojtaba Khamenei’s health condition may be contributing to the current power dynamics.

Efforts to remove Hejazi

At the same time, an unprecedented internal crisis is reportedly unfolding within Mojtaba Khamenei’s inner circle. Some close associates are said to be pushing to remove Ali Asghar Hejazi, a powerful security figure in the Supreme Leader’s office.

The tensions are rooted in Hejazi’s explicit opposition to Mojtaba Khamenei’s potential succession. He had previously warned members of the Assembly of Experts that Mojtaba lacks the necessary qualifications for leadership and argued that hereditary succession is incompatible with the principles outlined by Supreme Leader Ali Khamenei, according to informed sources.

Hejazi reportedly cautioned that elevating Mojtaba would effectively hand full control of the country to the IRGC and permanently sideline civilian institutions.

In the first week of the ongoing war, Israeli media reported that Hejazi had been targeted in an airstrike in Tehran. However, later reports indicated that he survived the attack.

https://www.iranintl.com/en/202604015321