Two parallel forces are reshaping U.S. drug pricing: litigation against the Inflation Reduction Act’s price controls and fresh White House policy proposals targeting insurers. Multiple drugmakers, including Novartis, have petitioned the Supreme Court to challenge IRA provisions; the industry’s legal push escalated as Novartis became the sixth company to file. Meanwhile, the administration rolled out a plan that shifts pressure toward insurers—proposing broader Most Favored Nation pricing and direct payments to consumers—heightening uncertainty over future pricing mechanics. The twin trajectories of courtroom challenges and executive policy moves create regulatory and commercial risk for manufacturers, payers and PBMs.