The Trump administration pledged this week to substantially reduce the high prices Americans commonly pay for their prescription drugs. It’s a promise that will undoubtedly come up short.
On Tuesday, President Donald Trump signed an executive order laying out the steps that the federal government, via the Department of Health and Human Services, is planning to take to lower drug prices. While some of the proposals are sound, others are unlikely to move the needle. Trump and GOP lawmakers are also preparing to, or already have, enacted other measures that could very well raise drug prices for many Americans.
A major plank of the executive order involves improving the Medicare Drug Pricing Negotiation Program: a Biden-era program that allows the government to directly negotiate the prices that Medicare will pay for some of the costliest prescription drugs on the market. The first round of negotiations occurred last year and resulted in ten drugs being discounted, though the price cuts won’t come into effect until 2026. The second round of negotiations involves 15 drugs and will conclude this year, with discounts arriving in 2028.
One of the most important drugs in this second round is semaglutide, the active ingredient in the type 2 diabetes drugs Ozempic and Rybelsus, as well as the obesity medication Wegovy. Semaglutide-based drugs cost upwards of $1,000 per month without insurance, and many eligible patients can’t access them due to the high list prices and lack of coverage. So if drug prices are truly cut, it would represent a genuine accomplishment. But again, any such discount wouldn’t arrive until 2028, in Trump’s (hopefully) last year of the presidency. In the meantime, his HHS has actually made it harder for people on Medicare to afford these medications.
Currently, Medicare cannot directly cover any weight loss medications, though it can provide coverage to people taking Ozempic and similar drugs for diabetes or certain obesity-related conditions, such as heart disease. The Biden administration proposed a rule last year that would have ended this restriction and opened up coverage to some 7 million Americans on Medicare and Medicaid by 2026. Earlier this month, however, the Trump administration dropped this proposal. HHS chief Robert F. Kennedy stated last week that the administration is considering some sort of “framework” to expand coverage, though RFK Jr. himself has repeatedly questioned the value of these drugs in the past.
Another wrinkle in Trump’s plan to lower drug prices concerns the so-called “pill penalty.” Drugs are not eligible for the negotiation program until they’ve been on the market for a certain amount of time. For small molecule prescription drugs, typically taken as pills, this delay is currently seven years (actually nine years before the price cut comes into effect). But for biologics—more complex, expensive-to-produce drugs typically taken by injection—the delay is 11 years (13 years really). In the executive order, Trump pledged to “align the treatment” of these two drug types in the program.
But as David Dayen at the Prospect and others have noted, the executive order doesn’t actually say that HHS will shorten the delay of biologics eligible for the program. And current pharma-backed GOP bills trying to address this discrepancy have done so by extending the exclusivity period of small molecule drugs to match that of biologics (solutions from the Democrats have tried to lower the period for both).
According to a KFF analysis released on Wednesday, a four-year delay would have removed more than half of the drugs included in the negotiation program to date, including semaglutide. Going forward, a longer exclusivity period for these drugs would cost the government plenty of potential savings and ultimately hurt the wallets of many Americans who rely on them.
In a statement Wednesday, Senator Ron Wyden (D-Oregon), a member of the Senate Finance Committee, argued that Trump’s executive order is certain to only weaken drug pricing reform.
“Just like his first term, Trump is all bark and no bite when it comes to lowering the cost of prescription drugs,” Wyden said. “This executive order is rife with goodies that Big Pharma has been begging for, primarily by weakening Medicare negotiation, which is going to mean higher prices for American seniors and families while the drug companies get a windfall to the tune of $10 billion.”
There are some nuggets of good ideas nestled in the executive order, such as further reducing the cost of insulin, trying to make it easier for states to import drugs (an initiative that started during the first Trump term), or accelerating the approval of generic drugs. But even these proposals are undermined by actions the White House has taken elsewhere.
The FDA has shed nearly 20% of its workforce as part of a DOGE-orchestrated “restructuring,” for instance, which is already hampering its ability to process potential drug approvals. And the administration has begun to lay the groundwork needed to impose tariffs on drugs imported into the U.S, which could lead to higher costs and drug shortages, particularly for generic drugs.
Nothing about Trump’s past or recent track record suggests that prescription drugs in America are about to get significantly cheaper. And if we’re truly unlucky, some drugs could become even more expensive soon enough.
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