Trump Drug Pricing Initiatives Face Scrutiny Over Actual Impact and Transparency

The Trump administration's efforts to lower prescription drug prices through pharmaceutical company deals and the TrumpRx program face questions about their actual impact, with analysis revealing that many announced benefits may be limited or misleading. President Trump and congressional Republicans' Big Ugly Bill included language to exempt and delay negotiations for drugs that would have otherwise been selected for negotiations this year, including Keytruda, Darzalex and Opdivo. These exemptions are projected to reduce savings from the negotiation program by $8.8 billion or more.

President Trump has proposed to further weaken Medicare drug price negotiations by prohibiting negotiations on all medicines until at least 11 years after first receiving FDA approval, meaning negotiated prices would not be available to Medicare and its beneficiaries for at least 13 years. This would effectively exclude many of these medicines from negotiations entirely, or shorten the period patients have access to lower negotiated prices to only one or two years before generics enter the market, blunting the impact of the law, potentially costing seniors and Medicare tens of billions more each year.

Nearly half of the drugs listed on TrumpRx (20 out of 43) have generics already approved by FDA that can be purchased more cheaply than the "discount" prices on TrumpRx. For some of these drugs, the difference can amount to hundreds of dollars per fill. Most of the products listed on TrumpRx are decades old; the median time on the market of the listed drugs is 26 years. In the vast majority of cases, it will be cheaper for patients with insurance to use their insurance instead of TrumpRx. Insurance typically covers most of the drugs listed on TrumpRx with low out-of-pocket costs.

TrumpRx claims to provide "the world's lowest prices on prescription drugs", but prices remain higher than in other wealthy countries. Wegovy deals on TrumpRx start at $199 for the first two monthly fills of the lowest dose and then rise to $349 per month; coupons must be used by the end of March 2026 to secure this deal. Meanwhile, Wegovy can be purchased for $186 in Denmark, $137 in Germany, and $92 in the United Kingdom.

As part of the deals, President Trump claims he got pharma companies to invest $400 billion in U.S. manufacturing since January 2025. But drug companies announced most of these investments prior to Trump's presidency. About 60-70% of the $400 billion reflect previously planned or accelerated projects.

In April 2025 Novartis and Roche were among the first pharma firms to announce huge investments into the US, with a combined $73 billion investment over the next five years. By comparison, over the last decade Roche has invested CHF63 billion in the US and CHF66 billion in Europe, of which CHF40 billion in Switzerland alone. Closer analysis shows that some investments aligned with earlier announcements by the same pharma companies. Novartis' April announcement mentions investments at ten sites in the US, including a new innovation hub and nine manufacturing facilities. The expansion of three of those sites had already been presented in 2024.

What is clear from later statements by the two firms is that investments are going ahead. Both companies have received official approvals, signed leases with real estate firms and broken ground on construction sites. In January 2026, a company CEO said he intended to raise the US share of global investment to 50%, and he confirmed his company had signed a contract with the US.

In early February 2026, the US launched TrumpRx, a federal direct-to-consumer website that claims to list the lowest US prices for branded prescription drugs. For now, 43 drugs are available on the website, but according to the deals between pharma and the US, several other treatments will be added, including Novartis' multiple sclerosis drug Mayzent, to be sold for $1,137 instead of the list price of $9,987, and a flu medicine to be sold for $50 instead of $168. This means that on paper Novartis and Roche will sell drugs at a lower price to patients than what they currently pay. But those figures are misleading as most drugs benefit from considerable discounts and aren't sold for the publicly available list prices. TrumpRx is available to anyone in the US but is mostly appealing to uninsured Americans (roughly 8 to 10% of the population).

The drug industry, Wall Street analysts and even a CMS Administrator have all predicted minimal financial impact from Trump's dealmaking with pharma, suggesting that these agreements will have little impact on U.S. drug pricing and affordability. One administrator suggested drug companies helped "design a plan that doesn't hurt [them]."

The Centers for Medicare & Medicaid Services is testing alternative methods for calculating drug manufacturer rebates through the Global Benchmark for Efficient Drug Pricing Model (GLOBE Model) and the Guarding U.S. Medicare Against Rising Drug Costs Model (GUARD Model). Rebates will be required when the U.S. price exceeds an international reference price benchmark, bringing U.S. prices more in line with the lower costs paid in similar countries. GLOBE is expected to result in $11.9 billion in federal savings from 2026 to 2032 and $6.2 billion in Medicare beneficiary out-of-pocket savings from 2026 through 2031. GUARD is estimated to reduce Medicare spending by $14.1 billion from 2028 to 2033. In comparison, the Congressional Budget Office estimated that Medicare drug price negotiations would save the program nearly $100 billion between 2026 and 2031.

In the regulatory impact analysis for GUARD, CMS assumes that "manufacturers will negotiate more aggressively for upcoming selected drugs in the IRA's Medicare Drug Price Negotiation Program, so that the maximum fair prices would be closer to the ceiling prices specified under the IRA than assumed absent the model." For GUARD, CMMI estimates this will lead to increases in beneficiary cost-sharing and beneficiary premiums, totaling $3.6 billion in additional costs to Medicare recipients.