Credit Where It’s Due — and Questions That Still Need Answers (Part 1 of 2)

By ALDP Co-Founders Michael Glassner and Jason Young

President Trump deserves real credit. Not everyone in the drug-pricing debate will agree. But at Americans for Lower Drug Prices, we say it because it’s true – and because intellectual honesty is the only way to win the long game on an issue this important. Let us explain more.

When the President signed his executive order directing the Department of Health and Human Services to explore Most Favored Nation drug pricing, and then followed it with the launch of TrumpRx.gov one month ago, he did something that most Washington insiders had long considered politically impossible: he forced the pharmaceutical industry to the table. Just as President Biden’s Inflation Reduction Act broke a 20-year logjam on Medicare drug price negotiation, President Trump is now demonstrating that executive leadership can move an industry that has resisted change for decades.

We applaud that. We applaud it without reservation and without asterisks. This is what political leadership on drug pricing looks like, and Americans who have struggled to afford their medications – at the pharmacy counter, at the doctor’s office, at the kitchen table when the bills pile up – deserve leaders in both parties who are willing to fight for them.

What TrumpRx Does, and What It Doesn’t

TrumpRx.gov launched with 43 medications (now 44) available at prices benchmarked to what peer nations pay. For some patients – particularly those who are uninsured or underinsured and paying full price out of pocket – this is a meaningful and immediate benefit. We are especially encouraged that some GLP-1 medications, which treat obesity and type 2 diabetes, and which have demonstrated extraordinary health benefits, are accessible and potentially more affordable through the platform. For patients who have been rationing insulin, skipping doses of essential medications, or simply going without, TrumpRx represents progress toward genuine relief.

But relief for some patients on 40+ drugs is not a solution for all patients and all drugs. The U.S. market includes thousands of medications. The patients who most need help – those on complex medication regimens, those in rural communities with limited pharmacy access, those on Medicaid navigating a system that often already underpays for their care – are not necessarily the patients best positioned to benefit from a digital direct-to-consumer purchasing platform. TrumpRx is an important start. It is not a cure-all.

The Fine Print the Industry Hoped You Wouldn’t Notice

Here is where we have to be honest with you about what is emerging from the details of TrumpRx – details that the pharmaceutical industry has, characteristically, preferred to keep quiet.

The agreements between the administration and drug manufacturers are confidential. The public cannot read them. But publicly traded drugmakers are required to disclose material business arrangements to their investors, and in recent earnings calls and securities filings, a critical detail has surfaced: some of these agreements appear to last only three years.

Three years.

The pharmaceutical industry did not agree to three-year pricing commitments accidentally. Three years is short enough to be financially manageable and long enough to generate positive headlines – while aligning roughly with the next presidential election cycle. If the political environment shifts, those deals don’t get renewed on the same terms. And the manufacturers understand that.

This is not a new playbook. Drug companies have a long and well-documented history of offering limited-time access programs, patient assistance initiatives, and voluntary pricing concessions precisely when structural reform is gaining momentum – and then allowing those programs to quietly expire when the political pressure eases. TrumpRx, as currently structured, could fit that pattern. We have not seen that the industry has changed its fundamental behavior. It is more likely that it has made a calculated, time-limited concession while hoping that the political will for deeper reform dissipates.

We do not believe it will. And that brings us to what needs to happen next.

Praising Progress While Demanding More

Americans for Lower Drug Prices was founded on a simple premise: the problem of high drug prices in America is not a Republican problem or a Democratic problem. It is an American problem, and it requires sustained, bipartisan solutions. We have praised the Inflation Reduction Act’s Medicare negotiation provisions. We praise the aims and work to date of TrumpRx. And we are here to tell you that praising both is not fence-sitting: it is the only intellectually honest position available.

What both initiatives share is the recognition that manufacturers will not voluntarily lower prices unless they are required or strongly incentivized to do so. TrumpRx proves that premise as powerfully as anything that has come before it. When our political leaders show the will to act, the industry moves. That is the lesson, and it is the lesson we intend to use. In Part 2 of this series, we will make the case for what durable, structural reform actually looks like – and why the three-year clock now ticking on some TrumpRx agreements makes the urgency of state-level action more pressing than ever. The window is open. The question is whether policymakers will use it.