The launch of TrumpRx has been framed as a breakthrough moment in lowering U.S. drug prices. The website promises to find “the world’s lowest prices” on prescription medicines and applies what it calls a “most favored nation” principle. At first glance, that sounds compelling, especially in a country where patients have long paid far more for medicines than people in other wealthy nations.
But a closer look suggests that TrumpRx is less a revolution in drug pricing and more a well-packaged reflection of changes that were already underway in the marketplace.
TrumpRx highlights examples like Gonal-F, claiming U.S. cash prices are now lower than in Canada, around $252 per pen in the U.S. versus $355 in Canada. That raises immediate questions. Will Canadian regulators respond by lowering their own prices? If so, will we end up in a downward spiral that makes it harder for pharmaceutical companies to recoup the billions they invest in research and development?
This matters because drug pricing isn’t just about today’s budget pressures. It is about whether we will still have robust innovation pipelines tomorrow. Short-term wins for patients and governments could come at the cost of long-term medical progress, leaving many diseases still untreated or incurable.
A major issue with TrumpRx’s comparisons is that they rely heavily on U.S. “list prices,” which are largely fictional. In the U.S., almost nobody actually pays the list price because insurers negotiate deep discounts behind the scenes. In many other countries, however, list prices are closer to the real prices patients or national health systems pay. Comparing the two as if they were equivalent is misleading.
This problem also appears on TrumpRx’s homepage with GLP-1 drugs like Wegovy and Ozempic. The site prominently displays entry-level starter doses, the first month’s dose, rather than the full therapeutic dose patients will need long-term. That skews the perception of affordability. Moreover, direct-to-consumer programs from manufacturers like Novo Nordisk and Eli Lilly already offer very similar prices to what TrumpRx showcases.
To be clear, there is a genuinely positive trend here. Cash-paying patients in the U.S. are finally getting fairer prices. For years, uninsured patients, high-deductible patients, or those whose insurance didn’t cover a drug were often forced to pay sticker prices that were dramatically higher than what insurers paid. That was deeply unfair. As Michael F. Cannon puts it, “The best idea: Let workers control health care dollars.“
In the last few years, pharmaceutical companies have already been moving toward direct-to-consumer models, cutting out layers of intermediaries like pharmacy benefit managers. This shift has begun to bring cash prices closer to what insurers actually pay. TrumpRx didn’t create this. It is largely amplifying it.
In fact, many of the drugs listed on TrumpRx can only be purchased directly from manufacturers, not through traditional pharmacies. That reflects a broader restructuring of drug distribution that was already happening, driven by industry frustration with a pricing system bloated by middlemen.
One genuinely good aspect of TrumpRx is that it does not add yet another payment intermediary. Pharmacies are still paid directly by manufacturers or wholesalers rather than through a new government-run clearinghouse. That simplifies the system rather than complicating it further.
Still, portraying TrumpRx as a major government achievement deserves skepticism. The private sector had already been moving in this direction. Even organizations like America’s Medicines, run by PhRMA, already direct patients to manufacturers’ direct purchase programs that existed before TrumpRx.
As Dr. Jeffrey A. Singer has warned, injecting government too deeply into drug sales risks crowding out private innovation and introducing political favoritism, coercion, and regulatory corruption.
What we should really want is not flashy government websites, but meaningful deregulation that makes it easier for patients to buy directly from manufacturers. Red tape that prevents or complicates these transactions should be cleared away.
More broadly, we need policies that give patients real financial incentives to seek lower prices, such as expanded Health Savings Accounts. When patients are insulated from costs through full indemnity insurance, they have little reason to ask for discounts, and savings rarely reach them.
In the end, TrumpRx looks less like a bold reform and more like a PR stunt that rides on trends the market had already created. The real work lies in empowering patients, reducing bureaucratic barriers, and preserving the incentives that fuel pharmaceutical innovation.
