No Patient Left Behind released a report arguing that foreign health technology assessments used in countries such as Canada and Germany undervalue innovative medicines by about 90%. The group says traditional quality-adjusted life-year approaches undercount societal benefits and other advantages used in pricing negotiations. The report frames HTAs as a bargaining tool that can drive access-denying coverage decisions and lower prices while shifting the innovation burden back onto the U.S. It cites examples including outdated willingness-to-pay thresholds and calculations that focus narrowly on patients rather than spillover benefits to families and society. The findings also echo complaints previously made by major European pharma executives in a letter to the EU, as the U.S. considers renewed pricing approaches such as Most Favored Nations-style benchmarks.