Will TrumpRx Actually Lower Drug Prices?
- Oct 16, 2025
- 4 min read
In this October 2025 episode of WBUR's On Point, Dr. Jerry Avorn joins host Meghna Chakrabarti and Sarah Emond, president and CEO of the Institute for Clinical and Economic Review (ICER), to dissect the Trump administration's TrumpRx initiative, analyze the deals struck with Pfizer and AstraZeneca, and explain why the United States pays dramatically more for prescription drugs than every other wealthy nation on earth.
Why Americans Pay Double
Dr. Avorn begins not with TrumpRx but with a diagnosis of the underlying problem: the United States is the only country on earth where a drug costs whatever its manufacturer wants to charge, and where the government is legally prohibited from pushing back on those prices. This situation, he explains, has three structural roots. First, the basic market framework allows drug companies to set prices without meaningful counterpressure. Second, when the Medicare drug benefit was written into law in the early 2000s, a provision was inserted — championed by Congressman Billy Tauzin, who shortly afterward left Congress to become head of the pharmaceutical industry's lobbying organization — that explicitly made it illegal for the government to negotiate drug prices. Third, Medicare and Medicaid are required to cover virtually all FDA-approved drugs, eliminating the option of simply declining to pay for overpriced medications. The result: up to 20% to 25% of Americans report being unable to fill the prescriptions their doctors write for them, while Americans pay roughly twice the per-capita drug costs of people in other wealthy industrialized countries.
What TrumpRx Actually Does — and Doesn't Do
On September 30, 2025, President Trump announced that Pfizer had agreed to offer its medications to Medicaid at most-favored-nation prices — meaning the lowest price paid by any comparable developed country. AstraZeneca struck a similar deal shortly afterward. Both companies agreed to sell through a new government website, TrumpRx, launching in January 2026. Dr. Avorn offers a careful assessment.
On the positive side, he credits the administration for raising public awareness that Americans pay roughly twice the per-capita drug costs of people in comparable countries, and for introducing the concept of most-favored-nation pricing into mainstream political discussion. Both are useful contributions to a long-overdue national debate.
On the limitations: the Medicaid piece of the deal is of modest practical significance because Medicaid already receives deeply discounted drug prices by law, and Medicaid patients typically have near-zero copays. Lowering prices further for Medicaid — while potentially helpful to state budgets — will not help the patients who will be losing Medicaid coverage under the One Big Beautiful Bill passed earlier in 2025, which Dr. Avorn notes will substantially reduce Medicaid enrollment. As for TrumpRx itself, Dr. Avorn points out that at the time of the interview the website consists primarily of a large photograph of President Trump and an image of an American family on a beach — no actual drug prices or program details. The site will only be relevant to people without health insurance, since those with any form of coverage — Medicare, Medicaid, Veterans Administration, or private insurance — will not be able to use their insurance on TrumpRx. He also raises concern that fragmenting drug purchasing across multiple direct-to-consumer platforms — TrumpRx for some drugs, GoodRx for others, direct-to-consumer sites for still others — could erode the role of the pharmacist as a professional who monitors a patient's full medication regimen for dangerous interactions.
On the Trump administration's claim that discounts would range from 50% to 100%, or even 1,000%, Dr. Avorn notes that 100% would mean the drugs are free, and anything above 100% would mean companies pay patients to take them — making those figures mathematically incoherent. He also observes that Pfizer's stock price rose approximately 10% in the two trading days following the announcement, suggesting that financial markets, whose participants understand the economics of these deals at least as well as anyone, did not view the arrangement as damaging to Pfizer's interests.
How Other Countries Do It
Sarah Emond of ICER explains that most other wealthy nations use a process called health technology assessment, in which an independent government body evaluates how much better a new drug actually is for patients compared to existing treatments, and what price is therefore appropriate to pay. England's National Institute for Health and Care Excellence (NICE) is one example: every drug reimbursed by the UK health system must receive a positive assessment, and the price is then negotiated accordingly. The underlying math asks how much better patients feel and how much longer they live, then determines how much the health system should pay for that measurable health gain.
The NIH Question
Dr. Avorn returns repeatedly to a point he considers underappreciated in the drug pricing debate: the United States' most important contribution to global pharmaceutical innovation has been its public funding of biomedical research through the National Institutes of Health. He argues that if policymakers are genuinely concerned about sustaining drug innovation, slashing NIH funding — as the Trump administration has done — is precisely the wrong response. The majority of important new breakthrough drugs, his own group's research has shown, had their origins in publicly supported research. Pharmaceutical industry R&D, by contrast, is necessarily focused on patentable, near-market products rather than the basic science from which future generations of treatments will emerge.
What Would Actually Work
Dr. Avorn and Emond converge on a similar reform framework: drug prices should be tied to demonstrable clinical benefit, with generous rewards for drugs that genuinely help patients and substantially lower prices for drugs that are minimally better than existing alternatives. Dr. Avorn notes that the current system perversely disincentivizes true innovation by rewarding companies even when their drugs barely work — citing muscular dystrophy drugs approved by the FDA without meaningful evidence of benefit. The Biden administration's partial step — allowing Medicare to negotiate prices for a limited set of drugs — was meaningful, he says, but the underlying structural problem of untethered pricing remains unaddressed. Real reform, both guests suggest, requires linking what the United States pays for drugs to what those drugs actually do for patients.