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Pharma shouldn’t yet sound the alarm over most-favored nation drug pricing order from Trump

The news: President Trump issued an executive order this week aiming to equalize how much America and other developed countries pay for prescription drugs.

Unpacking the order: It’s a much broader version of Trump’s “most-favored nation” plan from his first term. Its core goal is to ensure that America doesn’t get a worse deal than other wealthy nations on brand-name medications.

In the next 30 days, the administration will convey price targets to pharma manufacturers to bring US drug prices in line with comparably developed nations.

  • If drugmakers don’t comply, the government says it will propose a rulemaking plan that imposes most-favored nation pricing while allowing more lower-cost drugs to be imported from overseas.
  • The order doesn’t specify which medications or in which health insurance markets the pricing changes could apply to.
  • The order also instructs HHS to create a mechanism in which Americans can buy their drugs directly from manufacturers at a most-favored-nation price, bypassing middlemen such as insurers and PBMs.

Zooming out: The administration believes that drugmakers discount their products to gain access to international markets while subsidizing those discounts by charging higher medication prices in the US.

  • The US has less than 5% of the world’s population, but funds around 75% of global pharmaceutical profits, according to the administration.
  • The order also cited research that US consumers pay over 3X the price other OECD nations pay for brand-name drugs.
  • Trump boasted that prescription drug costs in the US would be lowered by upward of 80% as a result of the order.

Americans are largely in favor of actions that rein in drugmakers' perceived profiteering. US voters were much likelier to say they’d prefer stopping pharma companies’ price hikes (72%) than keeping the government out of prescription drug price-setting (18%) when asked to choose between the two, per March 2025 polling from Arnold Ventures and Fabrizio Ward.

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