When President Trump talks about accomplishments of his second term, he often mentions the deals he's struck with pharmaceutical companies to lower drug prices. "We went from the highest prescription drug prices, by far, anywhere in the world, to the lowest prescription drug prices anywhere in the world," Trump said during his remarks at the midterm Republican National Convention in Dallas on Sept 10. "And that alone should get us a big victory in our midterms that are coming up." Last year on Sept. 30, the president and his health officials gathered in the Oval Office to announce a major agreement with Pfizer — the first of what he said would be a series of deals with pharmaceutical companies.
Eventually, the White House said 26 companies signed agreements, but they have not been made public. Trump refers to these agreements as "most favored nation" deals, meant to bring U.S. drug prices in line with what other wealthy countries pay for drugs. The most buzzed-about part of the first announcement was the creation of TrumpRx, a website for consumers to find discounts on some drugs if they choose not to use their health insurance.
But, as NPR has reported, the drugs available are limited, and most consumers will get a better price if they just use their insurance and pay the copay. But Trump's announcement also included another promise, for the low-income and disabled Americans who are covered by Medicaid: "Today Pfizer is committing to offer all of their prescription medications to Medicaid," he said on Sept. 30, 2025. "And it will be at the most favored nation prices.
It's gonna have a huge impact on bringing Medicaid costs down like nothing else." And Trump said he expected other drug companies would do the same. Medicaid covers 66 million Americans, and its net spending on prescription drugs grew by 46% between 2019 and 2024, costing taxpayers $46 billion dollars that year, according to the nonpartisan health policy research group KFF. But turning Trump's promises into an operational program has been difficult.
A year later, that effort has been plagued by uncertainties, delays and a general lack of transparency. The pilot program relies on voluntary participation, by both drug companies and individual states, which means the number of drugs that will be discounted, and the number of patients who will have access to those prices, could be lower than what Trump originally promised. Because the administration has refused to release the actual pharmaceutical agreements, it's not clear if participating companies have to offer Medicaid most-favored nation discounts for all their drugs.
NPR reached out to Pfizer and 16 other major drug companies that struck pricing deals with the Trump Administration over the past year. None would confirm to NPR that all of their drugs would be discounted in Medicaid, or say exactly which ones would be discounted. Gilead told NPR it is working with states to make "selected covered products available," including drugs that treat hepatitis C, hepatitis B and HIV.
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