President Trump has spent more than a year pushing pharmaceutical companies to sell Americans drugs at the same price they charge in other wealthy countries, using an approach the administration calls “most-favored-nation,” or MFN, pricing. The effort is aimed squarely at what Medicare and out-of-pocket patients pay at the pharmacy counter, and it has already produced real, named price cuts on specific drugs. It has not yet produced a single, government-wide rule that resets prices across every prescription Medicare covers — that piece is still being written.
What the May 2025 executive order actually directs
On May 12, 2025, Trump signed an order titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients.” The order instructs the Department of Health and Human Services, working with the Centers for Medicare & Medicaid Services, to communicate MFN price targets to drug manufacturers and to use every available tool to bring U.S. prices for Medicare and Medicaid in line with the lowest prices those same manufacturers accept in comparably wealthy nations. It is a directive setting a policy goal and instructing agencies to act on it, not a law passed by Congress and not, by itself, a price change that shows up automatically on a pharmacy receipt.
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The tariff leverage the administration added in April 2026
Nearly a year after the original order, Trump signed a second one on April 2, 2026, tying pharmaceutical import tariffs directly to whether a manufacturer signs onto MFN pricing. Under that structure, companies that commit to both MFN pricing and expanded U.S. manufacturing face a 0% tariff on their imports, generic and biosimilar drugs face 0% regardless, products from certain allied nations face 15%, companies with approved domestic-manufacturing plans face 20%, and patented pharmaceutical products from manufacturers that decline to participate face tariffs as high as 100%. The structure is designed to make holding out expensive rather than to force compliance outright, giving manufacturers a financial reason to negotiate rather than a legal mandate to comply.
The manufacturer deals already in place, and what they mean at checkout
Since September 2025, the administration has announced more than a dozen individual agreements with major drugmakers, including Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead Sciences, GSK, Merck, Novartis, Sanofi, and, most recently, Regeneron. According to the White House’s own December 2025 fact sheet on nine of those deals, list prices for patients purchasing directly through the TrumpRx.gov portal are falling sharply on drugs many older adults take regularly: the cholesterol drug Repatha from $573 to $239, the diabetes drug Januvia from $330 to $100, and the blood thinner Plavix from $756 to $16, among others. The same agreements give every state Medicaid program access to MFN pricing on those companies’ products. The discounts are real and already available, but they apply to drugs purchased directly through TrumpRx or covered under the specific agreements — not automatically to every prescription filled at a neighborhood pharmacy through Medicare Part D.
The Medicare-wide rules are still pending, not finalized
The regulations that would extend MFN-style pricing across Medicare more broadly are still working through the federal rulemaking process, and that distinction matters for anyone trying to figure out whether the policy already covers their own prescriptions. CMS has proposed two new payment models — GLOBE for drugs covered under Medicare Part B and GUARD for Part D — but neither has been finalized. The public comment period on both closed February 23, 2026, and a final rule for GLOBE is expected no sooner than 60 days before its proposed October 1, 2026 effective date. A related voluntary model for Medicaid, called GENEROUS, opened to manufacturer applications through April 30, 2026, but participation there is optional rather than required. Separately, members of Congress have introduced bills to codify MFN pricing into law, but neither has advanced out of committee, and lawmakers who track the issue say formal legislation is unlikely to pass this year — meaning the policy currently rests on executive branch action and voluntary manufacturer agreements rather than a permanent statute.
What a Medicare enrollee should actually expect at the pharmacy right now
For most people on Medicare, the honest picture is a mix of real savings and work still underway. Someone who buys a covered drug directly through TrumpRx.gov may already see a lower price if the manufacturer has signed on, and Medicaid enrollees in every state now have access to MFN pricing on products from more than a dozen companies. But a senior filling a routine prescription at a local pharmacy through Medicare Part D should not assume every drug carries a comparable discount yet, since the Medicare-wide payment rules that would make that automatic are still in the proposal stage. The most reliable way to check whether a specific medication is covered by one of the existing agreements is to search it directly on TrumpRx.gov rather than assume the broader policy push has already reached every prescription.
This article was researched and drafted with the assistance of AI and reviewed by The Financial Wire editorial team.
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David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
