Americans pay substantially more for prescription drugs than people in any other wealthy country. According to a RAND analysis , U.S. prices across all drugs averaged 2.78 times those in 33 comparison countries in 2022. Brand-name drugs drive most of that gap.

The Trump administration has made lowering drug prices a signature issue with a mix of tools: deals with drugmakers, tariffs, a government shopping website, new Medicare and Medicaid experiments and legislation.

Some efforts have real teeth. Others are mostly headlines. Here are eight things the administration is doing about high drug prices, and my view on whether each will work and why.

1. Drugmakers Are Signing Confidential ‘Most-Favored-Nation’ Deals

A May 2025 executive order directed HHS to align U.S. prices with the lowest prices paid in comparable countries. This is an approach known as most-favored-nation, or MFN, pricing. Pfizer signed the first agreement in September 2025. Since then, the White House says 26 companies have reached deals, about 90% of the branded drug market.

Their pledges: launch new drugs at prices comparable to the lowest in peer countries, offer MFN prices to state Medicaid programs and sell discounted drugs directly to cash-paying patients. In some cases, they also pledge to invest in U.S. manufacturing.

So, will it work? It could, but it is hard to know exactly what the deals are. The reason is that the agreements are confidential. After the advocacy group Public Citizen sued, HHS released the Pfizer and Lilly agreements in September. Yet, the drug lists and prices were blacked out. In the end, the launch-price pledges may matter most over time.

But there’s a workaround: if there is no foreign price, there’s nothing to match. Some drugmakers are already delaying or skipping launches in Europe to avoid creating low international benchmarks.

2. Tariffs Are The Stick Behind The MFN Deals

An April 2026 proclamation imposed a 100% tariff on imported patented drugs and their ingredients. Companies with both an MFN pricing agreement and an approved U.S. manufacturing plan pay 0% through January 20, 2029. Generics and biosimilars are exempt for now, and products from the EU, Japan, South Korea and Switzerland face a reduced 15% rate.

So, will it work? As leverage, yes. The tariff threat is a major reason so many companies signed deals. As a tool for lowering prices on its own, no. Tariffs are a tax on imports, and the zero-tariff exemption expires in January 2029, a built-in end date.

3. TrumpRx Offers Cash Discounts To A Narrow Group Of Patients

TrumpRx.gov launched in February 2026 with 43 brand-name drugs as a portal to manufacturers’ discounted cash prices. The White House says it now lists more than 1,000 branded and generic medicines and that patients have saved more than $700 million through the site.

So, will it work? For some patients. As I wrote when it launched, TrumpRx helps people who are uninsured, are in high-deductible plans or need drugs their plans do not cover, such as obesity or fertility medications. But cash purchases generally do not count toward insurance deductibles or out-of-pocket maximums. And most insured patients’ copays are lower than TrumpRx prices.

Also roughly 85% of Americans have prescription drug coverage, so for most of them, the site offers little. It also does not change the underlying prices insurers pay. Importantly, many of TrumpRx deals are not unique to the website. GoodRx, for example, already offers equally steep discounts on 33 of the drugs listed on TrumpRx.

4. Medicare Is Testing Prices Tied To Other Countries

On September 30, CMS finalized what’s called the GLOBE model. It requires drugmakers to pay Medicare rebates when prices for certain physician-administered Part B drugs exceed a benchmark based on 19 wealthy countries.

The most notable feature is its design. The model is being applied only in randomly selected areas covering about 25% of traditional Medicare beneficiaries. Beneficiaries in those areas could see lower out-of-pocket costs starting in April 2027.

A companion model for pharmacy drugs, GUARD , was proposed in December 2025 with estimated savings of about $15 billion, but it hasn’t been finalized.

So, will it work? In my assessment, these are the most promising pieces of the agenda. Because areas are randomly assigned, the results will show whether international benchmarks actually lower spending. Such a design is rare in health policy. CMS now projects only about $440 million in Part B savings over the life of the model, down from nearly $12 billion in the proposal.

A reason for the reduction is that drugmakers participating in GENEROUS, a related Medicaid model, are waived out. This leaves only about four manufacturers expected to take part. That makes GLOBE as much a stick to push companies into voluntary deals as a savings program. And GUARD, as proposed, is designed to lower Medicare’s costs, not necessarily what patients pay at the pharmacy.

5. Medicaid Is Getting Most-Favored-Nation Prices

On September 18, the White House announced that every state Medicaid program, plus Washington, D.C., and Puerto Rico, will receive MFN prices through GENEROUS. Under the model, drugmakers pay extra rebates to bring Medicaid’s net price down to the MFN price which is defined as the second-lowest net price among eight comparison countries, adjusted for national income.

So, will it work? I think it will, but the effect will be modest. The reason is that Medicaid already pays among the lowest net drug prices of any U.S. payer because federal law requires large manufacturer rebates. This limits how much more MFN pricing can save. One research team estimated federal savings of about $5 billion in a single year.

As of mid-September, binding state agreements were still pending and the specific drugs and discounts remained confidential. Public Citizen also reports that the released Lilly agreement carves the company’s GLP-1 drugs out of GENEROUS pricing. Medicaid enrollees already pay little or nothing for prescriptions, so they are unlikely to notice a difference.

6. Medicare Negotiation Continues, But With New Exemptions

The administration is carrying out the Medicare drug price negotiation program created by the 2022 Inflation Reduction Act (IR), signed by President Biden. Negotiated prices for 10 drugs took effect in 2026. In November 2025, CMS announced prices for 15 more drugs, including Ozempic and Wegovy, which take effect in 2027.

CMS estimates those prices would have cut Medicare’s net spending on the drugs by 44%, or about $12 billion, had they applied in 2024. It also projects $685 million in lower out-of-pocket costs for patients. A third round, for the first time including physician-administered Part B drugs, will take effect in 2028.

So, will it work? Yes. The IRA is the most durable and best-documented savings program on this list because it is written into law and has so far survived the industry’s legal challenges. Yet the 2025 tax and spending law expanded exemptions for drugs approved to treat rare diseases. This shields blockbusters such as the cancer drugs Keytruda and Opdivo from negotiation for longer. The Congressional Budget Office estimates that change will cost Medicare $8.8 billion over a decade, nearly 10% of the program’s originally projected savings.

7. New PBM Rules Target The Middlemen

New government funding legislation signed into law by President Trump in February 2026 includes the most significant federal pharmacy benefit management (PBM) reforms to date. Starting in 2028, PBM pay in Medicare Part D must be a flat service fee rather than tied to drug prices or rebates. PBMs must also pass 100% of rebates through to employer health plans, starting with most 2029 plan years, and meet new transparency requirements. The reforms passed Congress with bipartisan support.

So, will it work? I think it will. It targets one of the structural problems that drive high prices, but it is slow and limited. The changes also don’t begin until 2028 and 2029. The CBO projects only about $2 billion in federal savings over 10 years.

8. GLP-1 Deals Expand Access To Obesity Drugs

Under agreements with Eli Lilly and Novo Nordisk, the Medicare GLP-1 Bridge gives eligible Part D beneficiaries access to Wegovy, Zepbound (KwikPen only) and Foundayo for weight management at $50 a month. It runs from July 2026 through December 2027. The White House says more than 500,000 seniors are already using it.

So, will it work? For access, yes. Medicare has long been barred from covering drugs for weight loss, and this is the first large-scale workaround. But it is temporary. And the $50 copay does not count toward Part D’s out-of-pocket cap. Coverage after 2027 depends on a follow-on model, BALANCE, whose Medicare launch has been delayed. And as more people start these drugs, total Medicare spending will likely rise even as the price per prescription falls.

Will These Policies Stand The Test Of Time?

In many ways, the Trump administration has confronted drugmakers more aggressively than its predecessors. It has forced international price comparisons into the center of the debate and won concessions that previous administrations didn’t. The deals, tariffs and Medicaid agreements came together in months, not years.

But long-term effectiveness requires being written into law, like Medicare negotiation and PBM reform. Most of the rest are executive actions that are time-limited or narrowed by exemptions. Some of their effects will be difficult to measure, and a future administration could reverse them.

As a physician, my test is simple: can a patient afford to fill the prescription their doctor wrote?

Ultimately, the story of the Trump Administration and drug prices has not fully been written. Over the next year, watch for the GUARD final rule, the list of areas selected for GLOBE and the 2028 negotiated Medicare prices which are due by the end of November. Also track legal challenges from drugmakers and, above all, whether the rest of the MFN agreements are made public, with prices and drug lists intact.