FY2026-2035 · CBO February 2026 baseline

International Reference Pricing

Cap Medicare drug prices at 120% of OECD international average. Saves ~$100B. **Illustrative**: an unfitted reconstruction a long way from its published figure, shown for the shape of the policy rather than as an estimate of it.

Ten-year deficit effect, conventional-$801.0Breduces the deficit
With macroeconomic feedback and debt service-$898.0BFRB/US-Lite (Federal Reserve calibrated)
Checked against

Published score -$100.0B; this estimate is 701.0% away (unfitted reconstruction). Unfitted reconstruction, 701.0% from -$100B (RAND price-comparison study) — no constant is fitted to this figure. The target itself is this model's own estimate, not a published score.

No out-of-sample band: no pre-registered row scores a drug-pricing reform. The 44 pre-registered Tier 1 rows are the only tier that measures this model's accuracy, and none of them scores a policy of this kind.

Year by year

billions, conventional
Fiscal yearRevenueDeficit, conventionalMacro feedbackDebt serviceDeficit, dynamic
2026$0.0B-$80.1B-$14.2B-$3.2B-$69.1B
2027$0.0B-$80.1B-$16.3B-$6.4B-$70.2B
2028$0.0B-$80.1B-$14.2B-$9.6B-$75.5B
2029$0.0B-$80.1B-$11.0B-$12.8B-$81.9B
2030$0.0B-$80.1B-$8.1B-$16.0B-$88.0B
2031$0.0B-$80.1B-$5.7B-$19.2B-$93.6B
2032$0.0B-$80.1B-$4.0B-$22.4B-$98.6B
2033$0.0B-$80.1B-$2.7B-$25.6B-$103.0B
2034$0.0B-$80.1B-$1.8B-$28.8B-$107.1B
2035$0.0B-$80.1B-$1.2B-$32.0B-$110.9B

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Who pays

first year, by income group

This is a spending or sector policy, so there is no tax table by income group.

Economic effects

difference from the CBO baseline
GDP, summed over the window-1.13percent-years
Jobs at the largest effect-149K
Deficit effect of the GDP change+$79.3Bless tax collected
Deficit effect of interest on the debt-$176.2Bless debt, less interest
Fiscal yearGDP levelJobsUnemployment10-year rateGDP change, deficitInterest, deficit
2026-0.203%-130K+0.10 pt-0.01 pt+$14.2B-$3.2B
2027-0.233%-149K+0.12 pt-0.02 pt+$16.3B-$6.4B
2028-0.203%-130K+0.10 pt-0.03 pt+$14.2B-$9.6B
2029-0.158%-101K+0.08 pt-0.03 pt+$11.0B-$12.8B
2030-0.116%-74K+0.06 pt-0.04 pt+$8.1B-$16.0B
2031-0.082%-52K+0.04 pt-0.05 pt+$5.7B-$19.2B
2032-0.057%-36K+0.03 pt-0.06 pt+$4.0B-$22.4B
2033-0.039%-25K+0.02 pt-0.07 pt+$2.7B-$25.6B
2034-0.026%-17K+0.01 pt-0.08 pt+$1.8B-$28.8B
2035-0.018%-11K+0.01 pt-0.09 pt+$1.2B-$32.0B

FRB/US-Lite (Federal Reserve calibrated). Demand effects fade over five to seven years as monetary policy responds; there is no supply-side channel. The dynamic score is the conventional score, plus the deficit effects of the GDP change and of interest on the debt: -$801.0B + $79.3B - $176.2B = -$898.0B.

Other scoring models

exploratory
ModelTen-year deficit effectMethod
CBO-Style-$801.0BStatic + ETI behavioral response + optional FRB/US dynamic feedback
TPC-Microsim PilotCannot score thisInternational Reference Pricing (DrugPricingPolicy) does not map onto current microsim pilot reforms (income-tax rates, CTC, EITC, SALT, std deduction, AMT exemption).

No pilot model returned distributional output; the comparison is aggregate-only.

CBO-Style is the model behind the headline above. The TPC-style microsimulation is a pilot: where the two disagree, the gap tells you how much the answer depends on method. It is not an official range.

Limitations

Cite asWilse-Samson, Laurence. “International Reference Pricing.” Fiscal Policy Calculator, CBO February 2026 baseline, FY2026-2035. https://fiscal.lwilsesamson.com/explore/drug-reference-pricing