High drug prices are one of the most visible, and most destabilizing healthcare costs for many families. Americans routinely pay more for the same drugs than people in other countries. The announcement of TrumpRx directly confronts this inequity in a way that consumers can see and benefit from immediately. It’s a first step in his Great Healthcare Plan’s push to enshrine price transparency, expose the Fat Cat insurance companies, and fundamentally alter how healthcare financing operates.
For decades, prices have been hidden because opacity is profitable for industry, but this has been a trap for patients. TrumpRx changes that by establishing Most Favored Nation (MFN) pricing, a “best price” guarantee that means the United States government is demanding that drug companies charge Americans the same low price they already offer to other wealthy countries. It makes those prices visible, instead of hiding them through contracting gimmicks that pharmacy benefits managers (PBMs) and insurance companies have used to line their own pockets. It introduces a basic, but critical concept: drugs should have a knowable price, not a theoretical one. It is the prerequisite for accountability.
Recent Congressional action on PBMs required disclosure of many operational elements, but while such requirements are important to root out corruption, these reforms won’t immediately help consumers at the point of care. TrumpRx will by facilitating direct-to-consumer manufacturer pricing, bypassing the rebate-driven PBM channel altogether. It lets consumers see real cash prices, not the inflated artifacts that PBMs use to sustain their back-end profits. PBMs have gained power by having exclusive knowledge over prices. TrumpRx weakens that monopoly on information and proves that alternatives exist.
TrumpRx does not attempt sweeping price mandates (an action which the courts would immediately strike down). Instead, it applies MFN discipline through federal purchasing leverage (the same kind of leverage Amazon, Costco, and Walmart already use in the private sector). This MFN action fits within the established authority of the federal government. The result is not universal price control, but credible price anchoring, a far more durable fix.
TrumpRx provides broad consumer benefits. Cash-pay patients will immediately gain access to lower, transparent prices. Insured patients will know when their covered price is higher than a publicly available alternative. At its core, TrumpRx restores a basic consumer right: knowing the price of something before you buy it. While it is sure to be an impactful program, it does not try to solve every problem. What it does is introduce real prices into a market that has spent decades hiding them.
There are those who say that the plan does not go far enough: it does not mandate further PBM reform, fully restructure Medicare drug pricing, or universalize MFN pricing across the private market. While there is much that can be accomplished through executive action, those who offer these criticisms miss the point: these expanded ideas would require Congressional action and are outside of executive authority. TrumpRx is an immediate win for consumers, but its restraint is no accident. It reflects the judgment that lasting reform requires discipline.
TrumpRx is operating within the scope of what the executive can do alone but make no mistake—it intentionally sets up the case for additional efforts that can and should be undertaken—with or without Congressional action.
The Department of Health and Human Services (HHS) should immediately issue the Advanced Explanation of Benefits (AEOBs) rule as required by the No Surprises Act, which would give every American the actual price of their health care, including their out-of-pocket responsibility, before receiving care.
In addition, the Department of Labor (DOL) should expand transparency requirements to include employer and union health plans and finalize its proposed Improving Transparency into Pharmacy Benefit Manager Free Disclosure rule, which would expose PBM fees and strip out the middleman’s incentive to profit in the shadows. Finally, these agencies, as well as the Department of Treasury, should come together to enforce the Transparency in Coverage Rule.
And Congress can take this a step further by advancing The Patients Deserve Price Tags Act, a bipartisan proposal, sponsored by Senators Roger Marshall (R-KS) and John Hickenlooper (D-CO). Importantly, this bill applies across the entire healthcare system—not just prescription drugs. For prescription medications specifically, it requires that all drug prices, not just the ones included in MFN negotiations, are available to patients at the time of prescribing, before they commit to a purchase.
TrumpRx answers the question, “What should this drug cost?” and Patients Deserve Price Tags gets to the heart of what is happening, “Why are you charging me more?” It is that combination that reframes how Americans approach healthcare, with an expectation of transparency and patient power.
TrumpRx is an important first step, to giving Americans—finally—a healthcare system that puts patients first.
Dr. Monique Yohanan, Senior Fellow for Health Policy at Independent Women.
