President Donald Trump has unveiled a sweeping set of pricing deals with nine large drugmakers, marking the most extensive test so far of a US “most‑favoured‑nation” (MFN) approach that links selected prices to those in other high‑income markets. The agreements, detailed in a White House fact sheet on 19 December, cover Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead Sciences, GSK, Merck, Novartis and Sanofi.
Medicaid focus and TrumpRx channel
At the core is a commitment to extend MFN‑level pricing to state Medicaid programmes nationwide for a portfolio of products across high‑spend categories, including diabetes, autoimmune disease, respiratory conditions, viral hepatitis, HIV and oncology. The administration cites “billions of dollars” in expected savings, though it has not released underlying budget assumptions, leaving payers and investors to model the impact on net pricing, utilisation and rebate flows.
In parallel, the deals further establish TrumpRx, a direct‑to‑patient channel through which participating companies will offer selected medicines at steeply reduced list prices. The platform is expected to make visible a set of headline cash prices that may sit uncomfortably alongside the existing rebate‑driven model, raising questions about how commercial and pharmacy benefit contracts will evolve.
Industrial policy and global context
The White House is also positioning the package as an industrial and supply‑chain measure, with the nine companies pledging at least $150bn in US manufacturing investment and donating active ingredients for key therapies to a federal strategic reserve. Contributions from several firms are intended to reinforce resilience for critical products used in acute care, chronic disease management and emergency response.
The move lands against a backdrop of a 2025 that has kept sustained pressure on branded drug pricing, with MFN‑style concepts, inflation caps and transparency measures moving from rhetoric into concrete policy proposals and pilots on both sides of the Atlantic. Throughout the year, regulators and payers in the US and Europe have pushed harder on launch prices and post‑launch escalation, forcing manufacturers to engage more directly on net pricing, real‑world value and budget impact.
