Trump unveils ‘TrumpRx’ website and Pfizer deal

The Trump administration announced a new direct-to-consumer prescription drug website and a landmark agreement with Pfizer on Tuesday, marking the first success of the president’s campaign to implement international reference pricing. But health policy analysts are skeptical the initiative will translate into meaningful savings for most Americans.

The TrumpRx.gov website, expected to launch in early 2026, will serve as a referral platform directing consumers to manufacturers’ direct-purchase programs for medications priced at what Trump calls “most favored nation” rates — the lowest prices available in comparable wealthy countries. The government will not sell or distribute drugs directly, according to administration officials.

“The United States is done subsidizing the health care of the rest of the world,” Trump said during the White House announcement. The initiative follows months of pressure on pharmaceutical companies after Trump signed an executive order in May directing the Department of Health and Human Services to pursue international reference pricing.

Pfizer makes concessions under tariff threat

Pfizer became the first major drugmaker to agree to Trump’s demands, committing to sell all its prescription drugs to state Medicaid programs at most favored nation prices and offering steep discounts through the TrumpRx platform. The company will provide its menopause treatment Duavee at an 85% discount, bringing the price to $30, while its rheumatoid arthritis drug Xeljanz will be discounted 40%.

The agreement came one day before Trump’s deadline to impose a 100% tariff on pharmaceutical imports. Pfizer secured a three-year grace period from those tariffs and committed to invest $70 billion in domestic manufacturing and research.

According to a White House fact sheet, over 100 million Americans suffer from conditions treated by Pfizer’s medications. The company will also guarantee most favored nation pricing for all new drugs it brings to market.

A familiar approach with a troubled history

The strategy represents Trump’s second attempt at international reference pricing. During his first term, he finalized a similar rule for Medicare Part B drugs in November 2020, but it was quickly blocked by federal courts on procedural grounds. Three separate judges found the administration failed to provide adequate notice and comment opportunities. The Biden administration later rescinded the rule in December 2021.

This time, Trump is pursuing voluntary agreements rather than immediate regulation, though the May executive order threatens to impose pricing through rulemaking if drugmakers don’t comply. The approach differs substantially from the Inflation Reduction Act’s Medicare drug price negotiation program, which the Biden administration implemented successfully. That program, which Trump has criticized, produced negotiated prices for 10 high-cost Medicare drugs that will save an estimated $6 billion when they take effect in 2026.

Questions about accessibility and impact

The administration has not yet detailed critical implementation specifics, including how discounts will be calculated, whether the program will reduce overall drug spending, or how it will function for patients with insurance coverage. The discounts apply only to consumers paying out of pocket.

This structure raises questions about the program’s reach. Most Americans obtain prescription drugs through insurance — either private coverage, Medicare Part D, or Medicaid — where they typically pay copayments negotiated by their plans rather than list prices. The TrumpRx platform would require patients to bypass their insurance entirely and pay cash upfront, even when their insurance might offer lower out-of-pocket costs.

For Medicaid enrollees specifically, the impact remains unclear. While Pfizer has agreed to provide most favored nation pricing to state Medicaid programs, beneficiaries in that program already face minimal cost-sharing by design. The savings would primarily accrue to state and federal budgets rather than individual patients.

The White House has emphasized that the program covers medications treating conditions affecting 100 million Americans. However, the four drugs initially highlighted — Duavee, Eucrisa, Zavzpret, and Xeljanz — represent a narrow slice of the pharmaceutical market, all manufactured by Pfizer.

Industry responds with own platform

The pharmaceutical industry attempted to preempt Trump’s announcement by launching AmericasMedicines.com on Monday through its trade group PhRMA. The website aggregates existing manufacturer direct-purchase programs, which several companies including Eli Lilly and Bristol Myers Squibb have already established.

Additional drugmakers, including Novartis, Boehringer Ingelheim, AstraZeneca, and Bristol Myers Squibb, have announced they will participate in direct-to-consumer programs in recent days, according to industry reports. But these companies have not yet committed to full most favored nation pricing across their portfolios.

The administration indicated that additional manufacturers are negotiating deals or awaiting discussions, though no other agreements were announced Tuesday.

International pricing complexities

The most favored nation concept relies on comparing U.S. prices to those in countries including Canada, France, Germany, Italy, Japan, the United Kingdom, Switzerland, and Denmark. The administration says it will use net prices — what patients actually pay after rebates and discounts — rather than list prices.

But executing international reference pricing remains fraught with practical and legal challenges. During the announcement, Trump acknowledged his strategy might push prices up in other countries while bringing them down in America, calling that outcome “fair.”

Gerard Anderson, a professor of health policy at Johns Hopkins Bloomberg School of Public Health, was doubtful. “We’re unlikely to get the drug companies to voluntarily decrease their prices, and we’re not going to get the other countries to voluntarily increase their prices,” he said. “Countries like France and Switzerland are all not going to sit there and say, ‘Hey, now I want to pay more.'”

The administration has not detailed what enforcement mechanisms it would use if drugmakers fail to maintain international pricing commitments, or how it would verify compliance across global markets.

Political context and future outlook

Trump has long maintained that Americans unfairly subsidize pharmaceutical research and development for the rest of the world. U.S. patients pay roughly three times more for brand-name drugs than consumers in other wealthy nations, according to HHS data. Americans represent less than 5% of the global population but generate approximately 75% of worldwide pharmaceutical profits.

The announcement comes as Trump has maintained some elements of Biden-era drug pricing policy, including the $35 monthly insulin cap for Medicare beneficiaries and the $2,000 annual out-of-pocket cap on Part D prescription drugs, both established under the Inflation Reduction Act. The administration has also continued Medicare’s drug price negotiation program, though Trump signed an executive order in April directing HHS to modify the program’s implementation.

Whether TrumpRx will prove to be transformative reform or largely symbolic remains an open question. Ameet Sarpatwari, an assistant professor at Harvard Medical School, offered a blunt assessment: “I think it’s more underwhelming than what the president is touting. I think it’s more window dressing than the transformational sort of reforms that are needed to really provide relief to Americans struggling with high prices.”