In the closing months of 2025, President Donald Trump’s effort to reshape how Americans pay for prescription drugs has taken clearer form. What started as a campaign threat to slap tariffs on pharmaceutical imports has evolved into a series of deals with some of the world’s largest drugmakers — and a promise that patients in the U.S. will finally pay what those in other wealthy nations do.
So far, the White House has announced three major agreements, each built around a revived “most-favored-nation” policy that ties U.S. drug prices to the lowest charged abroad. Pfizer, AstraZeneca, and the duo of Eli Lilly and Novo Nordisk have all agreed to sell some of their products at steeply reduced prices through TrumpRx, a new federal website set to launch in 2026.
The initiative’s success will hinge on whether the discounts reach patients’ wallets or remain largely symbolic.
The deal that started it all
Pfizer’s late September announcement set the tone. Under the agreement, the company will sell nearly all its medications to Medicaid at prices similar to those paid in other high-income countries and slash costs for some consumers by as much as 100%. In exchange, Pfizer will avoid new tariffs on branded drugs by investing between $70 billion and $90 billion in domestic manufacturing and research.
To deliver the discounts, the White House is launching TrumpRx, a direct-to-consumer website whereby Americans will be able to purchase Pfizer drugs at prices officials said could be up to 80% lower than current list prices.
The move was hailed as a landmark by the administration, though The New York Times reported Oct. 1 that the discounts would likely have minimal effects at pharmacy counters, with most savings accruing to employers, private payers and Medicare.
AstraZeneca signs on
Ten days later, the White House added AstraZeneca to its roster. The U.K.-based manufacturer agreed to sell its medications to Medicaid at most-favored-nation prices and to apply the same standard to all new drugs it introduces in the U.S. Like Pfizer, AstraZeneca will make discounted versions of some products available on TrumpRx.
The company also pledged to invest $50 billion in American manufacturing and research, aligning with the administration’s push to bring drug production back to U.S. soil.
“A move that will save American taxpayers hundreds of millions of dollars each year,” President Trump said of the deal. Standing beside him, CMS Administrator Mehmet Oz predicted that by the end of the term, “95% of all drugs sold in America — branded and generic — will be available at most-favored-nation pricing.”
Whether that prediction holds depends on how many manufacturers follow suit. So far, other large companies have opted to raise prices abroad to meet the policy’s terms rather than slash those in the U.S.
GLP-1s enter the picture
The administration’s most consequential deal came in early November, when Eli Lilly and Novo Nordisk — the two dominant makers of GLP-1 drugs used to treat diabetes and obesity — announced they had agreed to bring their blockbuster medications under the new pricing model.
Starting in 2026, Medicare will cover these drugs for the first time, with a monthly price capped at $245 and a $50 copay for beneficiaries. Through TrumpRx, cash-pay customers will see prices for Wegovy, Ozempic, Mounjaro and Zepbound fall to around $350 per month, down from more than $1,000. Oral versions of the drugs, still pending FDA approval, could be priced as low as $150.
The companies also agreed to extend the discounts to all state Medicaid programs, invest billions in U.S. facilities — $27 billion from Lilly and $10 billion from Novo Nordisk — and apply most-favored-nation pricing to future products.
The American Medical Association called the agreements “a transformative step in the battle against chronic disease and obesity,” noting that the policies could make GLP-1 drugs accessible to millions who had previously been priced out.
Building the TrumpRx marketplace
The TrumpRx website, still in development, sits at the center of these efforts. Designed as a government-run marketplace, it will connect consumers directly with discounted prescription drugs — bypassing traditional pharmacy benefit managers and selling directly to consumers via the federal platform.
So far, the platform’s partners extend beyond drugmakers. Cigna and CVS have joined to offer discounted fertility medications through their pharmacy operations beginning in January. Mark Cuban’s Cost Plus Drugs will also partner, feeding its transparent pricing data to TrumpRx as a “referral site.”
“The biggest difference between how drugs are bought and sold [in the U.S.] versus every other Western nation is we have [pharmacy benefit managers]. They don’t,” Mr. Cuban said in a CNBC interview, praising the administration’s embrace of direct-to-patient models.
The unanswered questions
Despite the high-profile announcements, many unknowns of the pricing agreements remain. Pfizer’s collaboration covers only part of its portfolio, and AstraZeneca has not specified which drugs will appear on TrumpRx. Federal officials have yet to release a full list of medicines or confirm the precise discounts that will take effect when the website launches in 2026.
The rollout timeline is also unclear. The administration has said the TrumpRx platform will debut early next year but has not set a firm date or explained how patients will verify eligibility and purchase drugs.
Most of the announced discounts apply to Medicaid, while the Lilly and Novo Nordisk deals will also extend to Medicare in 2026. Because federal law already caps Medicaid prescription costs at $8 — and some states charge nothing — many enrollees may see little change in out-of-pocket costs.
Private insurance plans are not currently part of the program, and the administration has not said whether commercial payers will be asked to match the new prices. Pharmacy participation so far includes CVS Health and Cigna’s Evernorth, but the broader distribution strategy has not been outlined.
The White House has said additional drugmakers are in talks to join TrumpRx, which could expand its reach. Until the platform goes live, however, the scale of the savings — and who will benefit — is uncertain.
