TrumpRx Will Not Bring Down Drug Prices |
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A page on the TrumpRx site is displayed.
Millions of people across the U.S. ration and skip medicines because of an unaffordable system shaped by powerful corporate actors. To tackle this problem, President Donald Trump heralded TrumpRx, a government-branded drug discount website launched a month ago, as “one of the most transformative health care initiatives of all time.”
But the early returns tell a different story: Only 54 drugs are listed on the platform. As Stat News reported earlier this month, web traffic has plummeted from its launch-day peak.
Indeed, patients and policymakers should not confuse a glossy website with real reform. Our work researching drug pricing and healthcare affordability points in a different direction: public-sector innovations already being developed and tested across the country.
The limits of TrumpRx are significant. While the administration pitches the initiative as a transparent marketplace where patients can shop for the best price, it requires out-of-pocket purchasing, which benefits those who can afford to pay. For many drugs on the platform, monthly costs remain substantial. Consider GLP-1 medications for diabetes and weight loss: They still cost $200-$300 per month on TrumpRx, a price point that remains unaffordable for most Americans. And at least half of the drugs already have more affordable generic options available elsewhere.
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For the roughly 85% of Americans with insurance for prescription drugs, copays will be cheaper than anything on TrumpRx – and purchases via the site will likely not count toward deductibles or out-of-pocket limits. TrumpRx will have little long-term impact on the drivers of unaffordable medicines for these patients, such as manufacturers’ pricing power, shadowy intermediaries like pharmacy benefit managers, and insurer cost-shifting. Rather than improving drug affordability, a familiar pattern will continue to unfold: higher premiums and out-of-pocket costs for patients, as well as growing fiscal pressures for public programs like Medicare and Medicaid.
Recently, administration officials have touted price concessions from pharmaceutical manufacturers as “most favored nation” pricing, which ties U.S. drug prices to lower prices paid in other wealthy countries. However, these arrangements are limited to a small number of medications and may not be sustained. None are enshrined in legislation.
So where should policymakers turn instead? Public-sector innovations across the country are building durable solutions, rather than relying on voluntary, short-term deals. These innovations aim to reshape the conditions that determine affordability in the first place: who produces drugs, who negotiates prices and payments and who controls access at the pharmacy counter.
An important development for affordable medicines involves drug manufacturing. California’s CalRx, a state-backed initiative to invest in low-cost generic drug manufacturing, treats pharmaceutical production as essential public infrastructure. In January, the state launched CalRx-branded insulin glargine pens, which are offered at pharmacies for approximately $11 per pen – a fraction of the roughly $80 or more per pen that patients typically pay for brand-name long-acting insulin. The initiative directly takes on an insulin market dominated by a few corporations whose pricing power has led patients to ration. CalRx has also expanded access to naloxone, the overdose-reversal drug, and is pursuing albuterol, a staple medication for children with asthma. Legislators in states such as Michigan and New York are currently considering similar public manufacturing models.
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The public sector is also advancing new approaches in purchasing and payment that leverage government’s negotiating power. State subscription-based purchasing – sometimes called the “Netflix model” – has already shown what is possible. Louisiana and Washington used this approach for expensive hepatitis C treatments, negotiating lump-sum payments in exchange for dramatically lower costs and expanded treatment. This Congress, bipartisan legislation was introduced in the Senate to scale this program as part of a national hepatitis C elimination campaign. States could apply the same subscription model to GLP-1s and other drugs – trading volume guarantees for wider access.
The federal government could go further and exercise its existing legal authority to license patents on high-cost, public health – critical treatments to generic manufacturers – a step consumer advocates have urged the Trump administration to take for GLP-1s, where cost-related barriers are leaving millions of patients without access. Medicare drug price negotiation, authorized under the Biden administration’s Inflation Reduction Act, represents an important step already delivering results. It has begun shifting the U.S. away from a system where public programs must accept private monopoly pricing toward one where the nation’s largest payer – the federal government – can bargain. Expanding this program should be a priority for a future Congress or administration.
Finally, reforms must confront the intermediaries that control access to medicines even after manufacturers set prices. Pharmacy benefit managers shape what patients pay and which drugs insurers cover – often through opaque rebate arrangements and business models that disadvantage local pharmacies. While antitrust approaches are needed, alternative public interest models are also crucial.
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One such example is ArrayRx, a PBM partnership between several states designed to serve public purchasers such as state employee health plans and Medicaid programs. ArrayRx pools leverage among these purchasers and uses transparent contracting and rebate pass-throughs to reduce costs for patients and health systems. Models like ArrayRx point toward what a “PBM for the people” could look like: strengthening public negotiating power, reimbursing pharmacies fairly and ensuring that savings reach patients. More states are looking to join.
The lesson is straightforward. TrumpRx may generate headlines, but affordable access requires something far more consequential: Policymakers must invest in durable public capacity to govern drug markets in the public interest. The ideas and tools exist. What’s needed now is the political will to use them.
Victor Roy, M.D., Ph.D., is assistant professor of family medicine and community health at the University of Pennsylvania and senior fellow at the Leonard Davis Institute of Health Economics. He is also a fellow at the New School’s Institute on Race, Power and Political Economy and author of “Capitalizing a Cure: How Finance Controls the Price and Value of Medicines.”
Mara Heneghan is director of the Health and Political Economy Project at the New School’s Institute on Race, Power and Political Economy.
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Tags: public health, prescription drugs