US Most Favored Nation List: Denied Countries and Drug Pricing

The United States currently denies Most Favored Nation trade status to four countries: Cuba, North Korea, Russia, and Belarus.¹ Imports from these four face the higher “Column 2” duty rates in the US tariff schedule instead of the standard rates every other trading partner receives. The same phrase — Most Favored Nation, or MFN — is also used in a separate US policy area, prescription drug pricing, where it refers to tying what Americans pay for medications to lower prices charged in other developed countries.

What MFN Status Means in US Law

MFN is the baseline non-discrimination rule of international trade: any tariff benefit a country grants to one WTO partner must be extended to all 166 members.² Congress renamed MFN status to “Normal Trade Relations” in US law in 1998, but the concept did not change.³ Countries with Permanent Normal Trade Relations (PNTR) get the lower Column 1 rates in the Harmonized Tariff Schedule. Countries without it get Column 2, which is substantially higher across most product categories.¹

The practical gap between the two columns is large. When Russia lost its status, duty rates on certain titanium products jumped from 15% to 45%, and rates on most petroleum products doubled.⁴

The Four Countries Denied MFN Status

The reasons and history differ for each country on the list.

Cuba

Cuba has been denied normal trade treatment by the United States for decades. It is a WTO member but does not receive MFN tariffs from the US.²

North Korea

North Korea has likewise been denied MFN status for decades. Unlike Cuba, it is not a WTO member at all.²

Russia

Russia’s status was suspended on April 8, 2022, when President Biden signed the Suspending Normal Trade Relations with Russia and Belarus Act (H.R. 7108) in response to the invasion of Ukraine. The law subjects Russian imports to Column 2 rates and authorizes the President to raise tariffs further. The United States and other WTO members justified the action under Article XXI of the GATT, the national security exception.⁴

The stakes were significant. In 2021, the United States imported roughly $29.7 billion in goods from Russia, making it the 18th-largest US trading partner at the time.⁵ Alongside the tariff changes, the United States separately banned imports of Russian crude oil, petroleum products, liquefied natural gas, coal, seafood, spirits, and nonindustrial diamonds.⁴

Belarus

Belarus lost its status through the same 2022 law that revoked Russia’s, on the same date and under the same national security rationale.⁴

How Other Countries Got Off the List

The current four-country list is small because Congress spent decades graduating former nonmarket economies out of a conditional system. Under the Trade Act of 1974’s Jackson-Vanik amendment, the President could extend normal trade treatment to nonmarket economies on a conditional, annually renewed basis tied to freedom-of-emigration requirements, subject to congressional disapproval.⁶

Congress has since granted Permanent Normal Trade Relations to Albania, Armenia, Bulgaria, China, Czechoslovakia, Estonia, Georgia, Hungary, Kyrgyzstan, Latvia, Lithuania, Mongolia, Romania, Ukraine, and Vietnam.⁶⁷ Without PNTR, duties on over 95% of Chinese imports would have risen sharply; duties on toys, for example, would have gone from free to 70%.³

Could China Be Added Back?

In January 2025, bipartisan bills were introduced in both chambers to strip China of PNTR. The Restoring Trade Fairness Act (S. 206), introduced by Senator Tom Cotton, would impose a minimum 35% tariff on non-strategic Chinese goods and a 100% tariff on strategic goods, phased in over five years.⁸ The House companion was introduced by Representatives John Moolenaar and Tom Suozzi.⁹ The bill would also eliminate de minimis duty-free treatment (for shipments under $800) for goods from China, North Korea, Russia, and Iran.

As of early 2026, the bill remained in the Senate Finance Committee. The US International Trade Commission published a Federal Register notice in March 2026 examining the economic effects of revoking China’s PNTR.¹⁰ For the moment, China remains on the PNTR list.

Note: Recent Tariffs Are a Separate Track

The sweeping tariffs imposed on nearly all countries in 2025 and 2026 did not change the MFN list. They ran on separate legal authorities. The April 2, 2025 “Liberation Day” tariffs were imposed under the International Emergency Economic Powers Act and struck down 6-3 by the Supreme Court on February 20, 2026 in Learning Resources, Inc. v. Trump.¹¹¹²¹³¹⁴¹⁵ None of that added or removed a country from the PNTR denial list, which remains Cuba, North Korea, Russia, and Belarus.

The Other MFN: Drug Pricing

“Most Favored Nation” is also the name of a separate US policy that has nothing to do with tariffs. In drug pricing, it refers to the idea that the US government should not pay more for medications than other developed countries do.

On May 12, 2025, President Trump signed an executive order titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” directing the Secretary of Health and Human Services to communicate MFN price targets to pharmaceutical manufacturers within 30 days. The order refers to “comparably developed nations” without naming a specific list, and authorizes enforcement tracks including rulemaking, drug importation, antitrust action by the Justice Department and FTC, and Commerce Department review of pharmaceutical exports if manufacturers do not offer MFN prices voluntarily.¹⁶

Voluntary Deals: TrumpRx

Beginning in September 2025, the White House announced voluntary agreements with major pharmaceutical manufacturers under a platform called TrumpRx. Pfizer signed first, followed by AstraZeneca in October 2025, and Novo Nordisk and Eli Lilly in November 2025. Novo Nordisk and Eli Lilly agreed to provide GLP-1 weight-loss drugs, including Ozempic, Wegovy, Mounjaro, and Zepbound, at roughly $350 per month.¹⁷ By December 2025, nine additional deals had been announced, including with Amgen, Bristol Myers Squibb, Gilead Sciences, Merck, Novartis, and Sanofi. The hepatitis C drug Epclusa was listed at $2,425 under TrumpRx, down from a reported price of $24,920.¹⁸

Some deals bundled investment commitments. AstraZeneca pledged $50 billion in US manufacturing and R&D in exchange for three years of tariff immunity. Novo Nordisk committed $10 billion and Eli Lilly $27 billion in manufacturing expansion.¹⁹

The GENEROUS, GLOBE, and GUARD Models

Three formal regulatory models sit alongside the voluntary agreements.

GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) is a voluntary five-year program launched in January 2026. Participating manufacturers provide supplemental rebates to state Medicaid programs to bring net prices in line with international benchmarks. The reference basket has eight countries: the United Kingdom, France, Germany, Italy, Canada, Japan, Denmark, and Switzerland. The MFN benchmark is the second-lowest reported net price among them, adjusted by GDP per capita. AstraZeneca, Pfizer, and EMD Serono have announced participation.²⁰²¹ The White House has estimated $64.3 billion in savings over ten years.

GLOBE (Global Benchmark for Efficient Drug Pricing) targets Medicare Part B, which covers physician-administered drugs. It uses mandatory manufacturer rebates benchmarked against economically comparable countries. It would apply to single-source drugs with Medicare Part B spending above $100 million annually and cover 25% of Medicare beneficiaries.²² GUARD (Guarding U.S. Medicare Against Rising Drug Costs) targets Medicare Part D inflation rebates.²³ Both were published as proposed rules on December 23, 2025, with a public comment deadline of February 23, 2026.

Legal History

Drug-pricing MFN has been tried before. The first Trump administration issued a Medicare Part B MFN interim final rule in late 2020. Federal courts blocked it on procedural grounds in cases including Biotechnology Innovation Organization v. Azar and Association of Community Cancer Centers v. Azar, and the Biden administration rescinded it in December 2021.²⁴ Industry attorneys have signaled that legal challenges to the current GLOBE and GUARD proposals are anticipated, on grounds including the scope of CMS Innovation Center authority under Section 1115A of the Social Security Act, the major questions doctrine, and the Administrative Procedure Act.²⁵

1
U.S. International Trade Commission. What Do All the Columns Mean
2
Washington International Trade Association. Key Principles of WTO Trade
3
Congressional Research Service. China’s Most-Favored-Nation Status
4
Congressional Research Service. Suspending Russia and Belarus Normal Trade Relations
5
American Action Forum. Revoking Russia’s Most Favored Nation Trade Status
6
Council on Foreign Relations. Reassessing the Jackson-Vanik Amendment
7
U.S. Congress. H.R. 4444, 106th Congress
8
U.S. Congress. S.206 – Restoring Trade Fairness Act
9
Select Committee on the CCP. Moolenaar Introduces First Bipartisan Bill to Revoke China’s PNTR
10
Federal Register. Effects on the US Economy of Revoking China’s PNTR Status
11
SCOTUSblog. Supreme Court Strikes Down Tariffs
12
Federal Register. Imposing a Temporary Import Surcharge
13
Gibson Dunn. Section 122 Global Tariffs Invalidated by CIT
14
The Budget Lab at Yale. The State of US Tariffs
15
Peterson Institute for International Economics. Farewell to the MFN Non-Discrimination Principle
16
The White House. Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients
17
Truveris. TrumpRx and MFN Pricing
18
The White House. Fact Sheet: Largest Developments in MFN Pricing
19
Mintz. Pharmaceutical Policy in Motion
20
KFF. A Look at the GENEROUS Model
21
CMS. GENEROUS Model
22
CMS. GLOBE Model
23
Regulations.gov. Public Comments on GUARD and GLOBE Models
24
CMS. Most Favored Nation Model
25
Bloomberg Law. Trump’s Drug Pricing Proposals Draw Legal Questions From Pharma