Pricing by comparison

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NICK EICHER, HOST: Coming up next on The World and Everything in It: the battle over prescription drug prices.

The Trump administration is testing a strategy to lower prescription drug costs by linking U.S. prices to what other countries pay. A new website called TrumpRx.gov is the consumer-facing piece of that effort—but experts disagree on the scale of the impact.

WORLD’s Mary Muncy reports.

MARY MUNCY: At the launch of TrumpRx.gov, President Donald Trump highlighted what he called a dramatic shift in prescription drug pricing.

DONALD TRUMP: Novo Nordisk will be slashing the price, as an example, of Ozempic, from more than $1,000, to $199. And the price of Wegovy from more than $1,300, to $199. Nobody can even believe it, a 578% difference.

TrumpRx is the administration’s latest step in a broader effort to reduce prescription drug prices in the U.S. The website lists discounted cash prices for certain medications that manufacturers have agreed to offer. It does not dispense drugs and does not process insurance claims. Instead, patients pay out of pocket at participating pharmacies and use coupons.

The administration says those discounts are tied to what they call a “Most Favored Nation” policy. Meaning, an effort to link U.S. drug prices with what other wealthy countries pay. The theory is that Americans should not pay more for the same medication than patients in Europe or Canada. 

Officials say TrumpRx makes those government-negotiated prices visible to consumers.

Hannah Anderson with the America First Policy Institute says the goal is to benefit Americans while pressuring global markets.

ANDERSON: They were thinking, how do we both, like, give a way for people to shop around for the lowest cost of drugs, while we're also working with other countries to make sure that no one in America is paying a higher cost for these drugs than other countries.

Here’s how Administrator for the Centers for Medicare and Medicaid Services, Mehmet Oz described it:

OZ: It's free. You get to look at all the prices and you should not be buying drugs anymore going forward without at least checking to see if those medications are available at these discounted prices on TrumpRX.gov.

Right now, consumers pay out of pocket for the drugs. You can’t use insurance on the site, but Anderson says even the insured may benefit.

ANDERSON: More and more Americans look at their insurance benefit and say, ‘You know what, it might actually be cheaper for me over the course of the year to pay cash for this drug.’

While she says the site is most likely to benefit people without insurance or who need drugs that insurance doesn’t cover, it might also be a good option for those with high-deductible insurance. 

But insurance payments count toward an annual deductible and out-of-pocket maximum. Cash purchases usually do not. That means what looks cheaper in the moment may not be cheaper over the course of the year.

And sometimes, more options create confusion.

PESTAINA: There's concerns that people don't understand this.

Kaye Pestaina is the director of the patient and consumer protection program at KFF.

PESTAINA: Sometimes you look at something on on this site or other direct to consumer sites, it looks really cheap, but if you do the math, you might actually be paying less using your insurance.

TrumpRx doesn’t assemble every single possible discount or consider the prices of generic versus brand-name drugs… That means consumers will still need to shop—especially since the 43 drugs on TrumpRx are mostly brand-name. That’s a small fraction of the thousands of prescriptions on the market.

PESTAINA: On the most part, generics will work for most patients, but there are some instances where a provider will say the patient needs the brand only.

But having to shop isn’t new. Patients have been able to buy drugs using platforms like GoodRx for years, sometimes finding big discounts.

Right now, about 8 percent of Americans are uninsured: that’s about 30 million people who may benefit most from a cash-only option like TrumpRx, especially if more medications are added.

The administration argues the broader goal isn’t simply a discount website, but a shift in how global drug prices are set. They say TrumpRx is an outpouring of the Most Favored Nation strategy.

In December, the UK agreed to pay more for certain medications as part of trade negotiations—an example supporters point to as evidence of shifting price pressure.

But Brookings Institution economic fellow Marta Wosinska says comparing U.S. prices to Europe’s nationalized systems is complicated—and she questions whether “fairness” is the right benchmark.

WOSINSKA: Is that the problem that we want to solve, that we want to make it fair? Is that really the policy objective, or is it that we want to have lower drug prices? Because when you ask that question, you might end up with very, very different answers.

Instead, Wosinska thinks structural changes to the TrumpRx system would be a better option.

WOSINSKA: Figuring out a way to let these drugs be counted towards the deductible could actually be game changing for patients in high deductible health plans.

She doubts Congress will mandate Medicare Advantage participation, but:

WOSINSKA: You could imagine the administration using all sorts of levers that they have to potentially get the insurers to come to the table and work with that.

For now, supporters and skeptics alike agree that more competition in prescription pricing could benefit consumers. The larger question is whether TrumpRx remains a parallel, cash-only tool—or becomes part of a broader restructuring of how Americans pay for medicine.

Reporting for WORLD, I’m Mary Muncy.

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