We have seen enough Donald Trump–branded consumer pitches—Trump Steaks, Trump Vodka, Trump Airlines, Trump Watches—to know that the quality of the service is less important than giving the impression of something legitimate. That’s the spirit with which we should approach TrumpRx, an alleged website where Medicaid patients can purchase low-cost prescription drugs.
At a Tuesday press conference, Trump announced a TrumpRx.gov website set to launch in early 2026, with characteristically few details. There is no language about TrumpRx at the Department of Health and Human Services or its agencies, only a fact sheet at Whitehouse.gov. The only indication of what drugs will be available is vague language about a “large majority” of primary care treatments and “some select specialty brands.” The pharmaceutical giant Pfizer has announced a voluntary agreement to supply drugs for the website, but that agreement, Pfizer said, will be kept secret. (Public Citizen has issued a FOIA request for that deal text; an HHS spokesperson would only refer to the White House fact sheet.)
In fact, nobody will be able to buy drugs directly from TrumpRx at all. Mark Cuban, the owner of his own drug purchasing website called Cost Plus Drugs, told me via email that “I’ve been told it’s just a listing site and won’t actually sell anything … As long as they list or use Cost Plus Drugs, I’m good with it.” Senior administration officials have separately confirmed that this is the case.
A listing site—which would refer users to other places to buy pharmaceuticals—would filter people to the latest drug industry tactic to avoid patient anger over high prices: direct-to-consumer, or DTC, websites. The day before the TrumpRx announcement, the Pharmaceutical Research and Manufacturers of America, the top lobbying group for the industry, unveiled its own DTC site for exactly the same purpose called AmericasMedicines.com. Elli Lilly, Novartis, AstraZeneca, and even Pfizer already have their own “pharm-to-table” (not my expression, and I threw up a little in my mouth while writing it) sites.
The idea, in theory, is to eliminate the middlemen of insurance plans and pharmacists and pharmacy benefit managers that critics contend lead to higher prices. But these voluntary websites are not comprehensive, not cheaper unless you have no insurance, and not at all connected to the basic issue of high list prices for prescription drugs, which drain government and commercial insurance plans and enrich drug companies.
These websites can be good for a tiny universe of patients, but it does not impact the structural factors that keep drug prices high. “If the government used its coercive powers to force everyone in, there are ways it could work,” said Alex Lawson of Social Security Works, who has focused on high drug prices for several years. “But this is the same as Trump 1.0, a policy designed to get press conferences.”
THE IMPETUS FOR TRUMPRx is a series of letters released by the president to drug companies demanding that they give Americans “most favored nation” (MFN) pricing on prescription drugs, comparable to what other industrialized countries pay. Drugs are cheaper abroad because countries negotiate in bulk to lower those prices; in the U.S., that negotiation has been either privatized or specifically barred by law, and as a result drug companies can generally charge whatever they want.
Trump tried to implement MFN in his first term, and it went nowhere. (Amusingly, a late push—after Trump lost the 2020 election—was blocked by a federal judge; I’m sure Joe Biden can sympathize.)
Once again, this is a decent theory: Why should the U.S. pay more than other countries? Defenders of the drug industry argue that companies spend so much money on research and development that they must be able to recoup it, but of course pharmaceutical companies are incredibly profitable (as a rule, they spend more on advertising than research), and much R&D is financed or done directly by the U.S. government itself.
These voluntary websites are not cheaper unless you have no insurance, and not at all connected to the basic issue of high list prices.
The devil, of course, is in the details. Steve Knievel, an advocate with Public Citizen’s Access to Medicines program, worked up a list of unanswered questions regarding MFN. The net prices of other countries are confidential, so it’s unclear how the U.S. is obtaining that information or what formulas will be used to make MFN calculations. Some prices in Medicaid, which obtains sharp discounts, are lower than prices paid abroad already, implying that prices could potentially go up, depending on details. It’s not clear what drugs are included (some Pfizer drugs are apparently not part of the MFN deal, per their announcement).
It doesn’t appear that MFN prices will be available to patients with commercial insurance or Medicare. That represents the majority of U.S. patients. We also don’t know whether patients without insurance at all will be eligible. DTC prices typically do not count toward deductibles and out-of-pocket maximums because it’s off insurance, meaning patients will pay out of pocket for this and still have to meet deductibles later.
“If DTC (direct-to-consumer) prices remain higher than copays and coinsurance, patients with insurance will have no reason to pursue the DTC pathway,” Knievel wrote.
IN THEORY, THE DTC MODEL could work. “Anything that brings more transparency to pharma pricing is a good thing,” said Alex Oshmyansky, the CEO of Cost Plus Drugs, which buys direct from manufacturers and sells to consumers with a small, publicly disclosed markup.
But the prices at TrumpRx, or at industry websites that TrumpRx refers patients to, are separate and segregated from the prices most patients use: the ones that their insurance companies pay. The imperative within the industry has historically been to protect those high “list prices” at all costs. They are all too happy to dribble out “rebates” on a direct website to some patients, as long as the list prices remain the same.
For example, Novartis offers on its website an anti-inflammatory drug called Cosentyx. Patients who pay cash (i.e., don’t use insurance) get a 55 percent discount off the list price. Bristol Myers Squibb and Pfizer do the same on their DTC website for the blood thinner Eliquis, at a 40 percent discount from list price. By definition, this means that the list price remains in place for insurance payers, who are most of the payers of prescription drugs.
Segregating the high list prices, excluding many patients from accessing the lower ones, and excluding some drugs entirely from lower prices creates the impression that drug companies are voluntarily passing out a few freebies to take the heat off themselves. At best, it’s a nice benefit for lower-income people; at worst, it’s just a way for drug companies to capture the waste from middlemen in the system for themselves.
“The whole goal is to keep the price high somewhere,” Lawson said. “Then they can base all their equations off of it and rake in billions of dollars.”
DTC sites are also designed to push particular drugs, perhaps to crowd out generic alternatives that may be cheaper. They are also an advertising tool. “Pharmaceutical companies can also potentially use their DTC platforms to better engage with patients, create brand awareness and strengthen brand loyalty,” a note from law firm Debevoise & Plimpton explains.
Avoiding dealing with the list prices keeps a broken system going. “All these manufacturer websites are work-arounds. They don’t fix the heart of the problem,” said Douglas Hoey, CEO of the National Community Pharmacists Association. “Reforming the way PBMs and insurance companies operate is the only solution.” A reform bill to do just that has languished in Congress for months after a deal reached last year to pass it was scuttled by MAGA influencers like Elon Musk.
In reality, as a report from Sen. Bernie Sanders (I-VT) indicates, drug companies have inflated the price of 688 different drugs since Trump’s inauguration, including one drug for a rare liver disease that went up 1,555 percent. Another 87 drugs went up in price just since Trump asked companies in July to lower prices, including from Pfizer, the cooperating company in this announcement.
Pfizer is a good case in point, in fact. In a bid to force companies to do his will, Trump imposed 100 percent tariffs on pharmaceutical products made abroad. Pfizer got a three-year exemption from those and future tariffs in exchange for playing ball. (In fact, most major drug companies were mostly spared from the allegedly painful tariffs.) The thing that Pfizer is giving up—a limited, vague reduction in some prices for some drugs—is not a material harm to their profits at the expense of patients. Their stock jumped 6.8 percent on this announcement, and one stock analyst said “this appears largely benign” for the company’s bottom line.
I would expect other drug companies to follow Pfizer’s model; the downside is trivial, and the upside of getting Trump out of their hair is immense. Meanwhile, their fight against changes to list prices remains intact.
The Trump administration’s One Big Beautiful Bill Act included a provision that prevented certain high-cost drugs from being eligible for Medicare price negotiation, something drug companies lobbied hard for. This will protect several billion dollars in profits. The fact that drug companies continue to chip away at and even sue to block (so far unsuccessfully) drug price negotiation, while happily setting up direct-to-consumer websites to give a few people cheaper prices tells you about the game that’s being played here. If you want to cut drug prices, you negotiate to cut the actual price actually paid by significant numbers of patients, rather than push to industry-created websites that have select discounts for a few while keeping the real price the same.
The first instinct of expecting a Trump announcement to be an overhyped sham is once again confirmed as the sensible reaction.