White House, Pfizer Reach Agreement on Drug Discounts; Trump Announces TrumpRx

Months after first announcing the Most Favored Nation (MFN) executive order, the Trump administration has advanced it through an agreement with Pfizer. The deal with Pfizer would bring the pharma company’s drug prices more in line with the lower prices paid by other wealthy nations. In addition to announcing the measure, the president revealed a new government website, TrumpRx, to launch in 2026 that will allow Americans to directly purchase medicines from pharmaceutical companies at steep discounts.

According to Pfizer, this voluntary agreement is in response to the letter President Donald Trump sent to major pharmaceutical companies, compelling them to lower prices in the US to match the discounted rates offered in other developed countries. The “majority” of the company’s “primary care treatments” and some specialty brands will be available on the government website at savings as high as 85%, according to Pfizer, although the company said the average would be a 50% discount.

Among the drugs that will be available on TrumpRx at reduced prices are:

• Crisaborole (Eucrisa) for atopic dermatitis at an 80% discount
• Zavegepant (Zavzpret) for migraine attacks at a 50% discount
• Tofacitinib (Xeljanz) for the inflammatory conditions rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis at a 40% discount

Part of the agreement with the administration provides Pfizer with a 3-year grace period to avoid facing tariffs that the president announced he would enact on branded drugs manufactured outside of the US. The tariffs would take effect on October 1, but companies could avoid being penalized if they have a manufacturing plant being built.

“By working closely with the Administration, we are lowering costs for patients and enabling greater investment in the U.S. biopharmaceutical ecosystem by ending the days when American families alone carried the global burden of paying for innovation,” Pfizer Chairman and CEO Albert Bourla said in a statement. This is about putting all patients first and ensuring America remains the world’s leading engine of medical breakthroughs.”

Most Favored Nation Order Implementation

The pricing target set by HHS for drug prices under the MFN is the lowest price in an Organisation for Economic Co-operation and Development country with a gross domestic product per capita of at least 60% of the US’s GDP per capita. To achieve this, the administration had outlined 4 key steps to manufacturers:

• Extend the MFN pricing to all Medicaid patients
• Agree not to offer lower prices for new drugs to other developed nations
• Provide an avenue to sell medicines directly to patients
• Use trade policy to support manufacturers in raising prices internationally

“In case after case, our citizens pay massively higher prices than other nations pay for the same exact pill, from the same factory, effectively subsidizing socialism aboard [abroad] with skyrocketing prices at home,” said Trump. “So we would spend tremendous amounts of money in order to provide inexpensive drugs to another country. And when I say the price is different, you can see some examples where the price is beyond anything — four times, five times different.”

However, MFN faces significant legal and procedural hurdles. A similar MFN order from the Trump administration at the end of his first term in 2020 was ultimately blocked by federal courts for failing to follow proper rulemaking procedures, and this new 2025 order will likely face similar challenges.

During a recent webinar cohosted by The American Journal of Managed Care, Neal Masia, PhD, cofounder and CEO, EntityRisk, highlighted the ambiguity of the MFN order. He had suggested that the purpose of it might simply be to bring the industry to the negotiating table, which successfully happened with Pfizer.

“I think this is the administration saying to itself, ‘What's the worst imaginable thing I think I can do within the bounds of my authority, to the industry, to get them to the table so that they will announce and change some behaviors?’” he said. “You’re trying to solve a problem that is very, very tricky…with a blunt instrument…”

Other challenges of implementing MFN in the US can be seen by countries in Europe that have already succeeded. Ali Pashazadeh, MRCS, MBA, founder, chairman, and CEO, Treehill Partners, pointed to a “brain drain” of scientists that had left the UK for countries with better pricing, and Switzerland’s fall from grace as a center hub of biotech innovation.

“I understand the logic of doing it,” he said. “I understand the desire to get drugs to patients at a price parity which is comparable to other countries. All of that is absolutely logical. …the question is how it's implemented, and also the timing of implementation.”