Is Waiting the Riskiest Drug Pricing Strategy? Why Scenario Planning Is the Smart First Move on MFN

MFN—and other universal drug pricing policies—are often framed as discrete legal outcomes: Will it happen or not? Will it be narrow or broad? Delayed, diluted or overturned?

Those questions matter. But they can distract from the more immediate challenge leadership teams face today: how to plan when a policy’s impact is plausible, material and uneven—long before rules are finalized.

“MFN does not operate in isolation,” explains Prateet Minhas, MD, Managing Director in Consulting at Syneos Health. “Its potential impact intersects with economic volatility, payer pressure, global reference pricing dynamics and rising expectations for value demonstration. In that environment, waiting for certainty can quietly lock organizations into assumptions that no longer hold.”

This is where scenario planning can reframe the conversation, steering potential pratfalls into real-life decision-making. Instead of asking what will happen, scenario planning asks what could happen—and what breaks if it does and how your team is equipped to pivot in any situation.

The Hidden Cost of Waiting

Many strategic decisions feel reversible on paper, but in reality, they’re anything but.

Launch sequencing, global pricing architecture, evidence generation and contracting models often require years of lead time. Once set in motion, they are costly—and sometimes impossible—to recalibrate without disruption, lost leverage or delayed access.

When MFN-like policies exert pressure gradually rather than arriving as a single shock, the organizations most exposed are not those that misread the future—but those that failed to rehearse it. By the time policy clarity arrives, the most consequential decisions have often already been made.

Scenario planning is not forecasting. As Van Denburg cautions, “Scenario planning accepts uncertainty as a starting point.”

Instead of betting on a single outcome, it enables leadership teams to prepare for multiple plausible futures—and understand what holds, what breaks and what must flex in each one.

This approach shifts planning from reactive to anticipatory. Leaders are no longer waiting for the rulebook to be written —they are preparing to operate effectively across several versions of it.

By exploring multiple pricing policy scenarios, leadership teams can:

• Identify which decisions matter across all futures—and which only matter in some
• Stress-test assumptions that feel safe today but could fail under policy pressure
• Distinguish where flexibility is required versus where early commitment creates advantage
• Define clear signposts that indicate when to pivot—not just how