During his February 24 State of the Union address, President Trump took a victory lap on prescription drug prices. He touted “most favored nation” pricing, highlighted the TrumpRx website, and urged Congress to lock his approach into law.
Americans absolutely deserve lower drug prices. The problem is that the policy instinct in Washington is still the same: set prices from the top down, import foreign government pricing models, and call it reform.
That is not how you get sustainable relief for consumers, and it is not how you keep America first in lifesaving innovation.
If we want prices to fall and access to improve, we need to stop pretending that government price mandates are “market” solutions. What actually works is competition, direct purchasing options, and fewer middlemen.
TrumpRx is political theater riding on private sector trends
Trump showcased TrumpRx in the speech, even pointing to an early customer story and major discount claims.
In our analysis at the Consumer Choice Center, we explained why that framing is backwards. TrumpRx is presented as a breakthrough, but a closer look shows it is largely a slick portal reflecting changes already underway in the marketplace.
Here is the core issue: a lot of what TrumpRx displays is based on “list prices” that are often disconnected from what insured patients actually pay, because rebates and negotiated discounts happen behind the scenes. Comparing U.S. list prices to foreign prices as if they are equivalent can seriously mislead consumers about what is changing and for whom.
TrumpRx also highlights starter doses for some blockbuster drugs, which can skew perceptions of affordability compared to the long-term therapeutic doses patients actually need.
To be fair, there is one positive element: TrumpRx does not create a new government payment intermediary. In many cases, it is simply surfacing existing direct purchase pathways that manufacturers have already built.
That is also why the “achievement” narrative does not hold up. As STAT and others have noted, TrumpRx is unlikely to help most Americans, because most Americans are insured and their out-of-pocket costs are driven by plan design, formularies, deductibles, and the rebate-driven supply chain, not a coupon style website.
The best proof that competition works is the GLP-1 price story in 2025
If you want a real, recent example of prices moving in the right direction, look at GLP-1 medicines.
In 2025, the biggest shifts in consumer prices did not come from Congress importing European style price rules. They came from manufacturers changing how they sell, and from competition between companies.
Novo Nordisk rolled out major self-pay price reductions and direct access options for Wegovy and Ozempic, including a $349 monthly cash price for existing self-pay patients and an introductory $199 offer for early doses, distributed through broad pharmacy channels and direct options.
Eli Lilly responded with its own direct model, lowering self-pay pricing for Zepbound single-dose vials, including a $299 monthly price point for the lowest dose, promoted through Lilly’s direct channel.
That is what competition looks like in real life: rivals undercutting each other, experimenting with new distribution, and bypassing the rebate maze that rewards inflated list prices and PBM gatekeeping.
Then, on February 24, 2026, Novo Nordisk announced something even more telling. It said it will cut U.S. list prices for Wegovy and Ozempic by up to 50% starting January 1, 2027, explicitly addressing the fact that insured patients with coinsurance or high deductibles can be stuck paying based on list price.
This is the point Washington keeps missing: once the market starts moving toward direct competition and simpler pricing, even list prices, the “sticker prices” that have distorted the system, start to come down.
That is a consumer win, and it happened because of competition and channel innovation, not because we copied a European price board.
“Most favored nation” pricing is not a free market reform
The President’s “most favored nation” pitch sounds like common sense in a soundbite: if other countries pay less, Americans should pay no more than the lowest price abroad.
But that is not competition. That is international reference pricing, a form of government imposed price control. Even fact checks explaining the policy describe it as tying what the U.S. pays to the lowest prices in other wealthy countries.
And foreign prices are not “market” prices. In much of Europe, prices are set through centralized negotiation, rationed through reimbursement rules, and enforced through access restrictions and delays.
When people say “just do what Europe does,” they rarely mention the tradeoff: slower access.
If the United States wants to remain the place where patients are first in line for new cancer therapies, rare disease treatments, and breakthrough medicines, it should not import the very systems that normalize waiting.
Yes, Americans pay too much, but the fix is more competition, not more control
It is true that U.S. drug prices are higher than other countries. RAND’s international comparisons have found U.S. prices roughly 2.78 times higher on average, and brand-name drugs even higher versus peer countries.
Price controls have a hidden cost: patients lose access. New medicines launch first and most often in the United States, while price-controlled systems cover far fewer breakthrough treatments. One global access analysis finds 85% of new medicines launch in the U.S., but only 24% are publicly reimbursed in Australia and 21% in Canada, meaning patients simply do not get the same access. And even when those medicines do arrive, patients can wait a year or longer. In Australia, the average “patient access gap” has been reported at 591 days, more than 18 months
But the answer is not to lock America into other governments’ price caps. The answer is to fix the parts of the U.S. system that block competition and keep consumers from seeing savings.
That means:
- More direct to consumer options and fewer barriers to buying directly from manufacturers, which is already proving it can lower cash prices and reduce the middleman tax.
- Real PBM and rebate reform so lower net prices translate into lower out-of-pocket costs at the pharmacy counter, not bigger spreads for intermediaries.
Trump is right to talk about affordability. But if Washington’s solution is “import European price controls and call it reform,” consumers will pay another price: fewer choices, more rationing-by-delay, and slower access to the next generation of innovations.
America can lower drug prices and keep its innovation edge. The way to do it is not command-and-control health policy. It is markets that are open, competitive, and built around consumers rather than middlemen.
