The news: President Trump announced a new healthcare plan on Thursday aimed at lowering US healthcare costs. Many of the proposals would require congressional approval, although Medicare and Medicaid director Mehmet Oz told STAT the administration has already begun pitching the plan to lawmakers.

Here's how Trump’s new healthcare proposal, dubbed “The Great Healthcare Plan,” would impact different healthcare stakeholders:

• Pharma: The plan would formally adopt “most-favored nation” pricing, which requires pharma companies to set US drug pricing on par with other developed nations. It also calls for more prescription drugs to be made available as over-the-counter medicines (though the proposal lacked details about how that would happen).
• Insurance: The plan would redirect healthcare subsidies from insurers directly to consumers, who would use the funds to purchase insurance. It also proposes a cost-sharing program to lower Affordable Care Act plan premiums by 10% or more.
• PBMs: Some PBM payments, such as fees paid to employer brokers that the plan characterizes as “kickbacks,” would be eliminated.

Why it matters: Building on the Trump administration’s focus on drug pricing last year, the 2026 plan extends its regulatory crackdown to address persistent consumer struggles with healthcare costs and access.

• 16 of the 17 Big Pharmas targeted by Trump’s pricing demands in August have now struck government deals that include lower direct-to-consumer drug prices, most-favored nation prices for new drug launches, and US manufacturing in exchange for tariff relief.
• Almost half (47%) of US adults worry about how they’ll pay for necessary healthcare expenses in 2026, with 37% specifically concerned about prescription drug costs, according to a West Health and Gallup study from June to August.
• 23% of US adults believe the nation’s healthcare system is in a state of crisis—the highest level in 30 years, according to a November West Health-Gallup survey.

Implications for key stakeholders: While the administration wants to cut costs for consumers across the board, the proposed regulatory changes will create challenges and opportunities for every major healthcare stakeholder.

The proposal puts renewed pricing pressure on pharma companies after a year of heavy dealmaking in 2025. Making most-favored nation pricing a legal requirement, especially if it applies beyond new drug launches, would further limit pricing flexibility and hurt margins, although congressional negotiations could delay or narrow those changes.

The plan reinforces PBM’s expectations that they’d face regulatory action in 2026. While Trump only outlined plans to crack down on PBM payments labeled as “kickbacks,” the policy signals that PBM business models remain a key focus for both the administration and Congress, where several reform bills were introduced in 2025.

For insurers, sending subsidies directly to consumers could increase price sensitivity and plan switching. At the same time, keeping subsidies in place for consumers to spend on insurance coverage could help companies avoid the coverage losses expected after ACA subsidy expirations.