Trump Administration Prescription Drug Initiatives: What Employers Should Know

Trump Administration Prescription Drug Initiatives: What Employers Should Know
November 19, 2025 7 mins

Trump Administration Prescription Drug Initiatives: What Employers Should Know

Trump Administration Prescription Drug Initiatives: What Employers Should Know

The Trump Administration has introduced several initiatives aimed at reducing prescription drug costs. Here’s what these changes could mean for employer-sponsored plans.

Key Takeaways
  1. The Trump Administration’s proposals include “most-favored-nation” pricing, direct-to-consumer purchasing via TrumpRx, and greater transparency of the cost of prescription drugs and the fees paid to pharmacy benefit managers.
  2. Timing, scope and impact remain uncertain, with open questions for employer plans on pricing, use, rebates and compliance.
  3. Employers who keep up to date with policy changes will be better equipped to adapt their prescription drug benefits, ensuring they maintain valuable and cost-effective coverage for their employees.

Most Favored Nation Prescription Drug Prices and TrumpRx

Since taking office, the Trump Administration has stated it will make prescription drug affordability a top priority. The most notable effort is the push for most-favored-nation (MFN) pricing.

On May 12, 2025 President Trump issued an Executive Order that requires drug manufacturers to sell medicines in the U.S. at prices no higher than those in other developed countries. The Administration subsequently announced proposed tariffs on drug imports for manufacturers who do not agree to MFN pricing and other requirements. And in October it introduced the launch of TrumpRx.gov, a new government-operated website designed to allow individuals to directly purchase select medications from participating manufacturers at discounted prices.

As of November 6, 2025, the Trump Administration has reached agreements with five drug manufacturers that include commitments to MFN pricing (except EMD Serono), investments in U.S. manufacturing and direct-to-consumer discounts on select drugs via TrumpRx. All five companies received multi-year exemptions from certain tariffs on pharmaceutical imports, and other pharmaceutical companies are expected to consider similar actions in the future. The drug pricing commitments from these companies include:

  • Pfizer agreed to offer its portfolio of drugs at MFN prices for state Medicaid programs and will offer discounts through TrumpRx for some of its primary care and select specialty drugs.
  • AstraZeneca agreed to MFN pricing for state Medicaid programs and will offer discounts through TrumpRx on prescription drugs for chronic disease patients.
  • EMD Serono plans to offer its full portfolio of in vitro fertilization (IVF) therapies through TrumpRx at reduced prices.
  • Eli Lilly and Novo Nordisk agreed to MFN pricing on their products for state Medicaid programs. The deals also include negotiated direct-to-consumer prices through TrumpRx and Medicare for four key GLP-1 drugs: Novo’s Ozempic and Wegovy, and Lilly’s Zepbound and Orforglipron (pending FDA approval). Eligible Medicare beneficiaries will pay a $50 monthly copay for the GLP-1 drugs. Additionally, the agreement provides for reduced costs on other Eli Lilly and Novo Nordisk medicines when purchased through TrumpRx.

Separately, an agreement with Cost Plus Drugs, an on-line pharmacy will provide TrumpRx access to its application programming interface (API), enabling the platform to pull real-time prescription drug pricing data.

While these initiatives may ultimately result in reducing the cost of prescription drugs in certain cases, many questions remain for employers.

How will MFN discounts impact employers?

The MFN prices in the agreements with the drug manufacturers appear to apply only to state Medicaid programs and only for certain drugs. Medicaid programs already purchase drugs at competitive prices, so it isn’t clear whether MFN pricing represents a lower price point than those that Medicaid already offers. Discounts of up to 50 percent on certain drugs have also been announced, but there are no details yet on how those discounts will be calculated. While these initiatives may ultimately result in the cost of prescription drugs being reduced in certain cases, many questions remain.

How will TrumpRx work?

Details are limited, but the Administration is expected to share more information and launch a website in 2026. Prices offered through pharmaceutical manufacturer direct-to-consumer (DTC) programs may not necessarily be lower than those available through commercial insurance plans. For example, the White House specifically mentioned that the drug Xeljanz, a medication used to treat rheumatoid arthritis and other conditions, will be available at a 40 percent discount. Xeljanz is covered by many commercial insurance plans at an estimated 50 to 55 percent discount after including rebates.

How will TrumpRx impact employer-sponsored health plans?

To date, pharmaceutical manufacturer DTC programs operate outside of the current insurance system and do not directly affect medication costs paid by group health plan sponsors and individuals who wish to use their benefit plan to purchase medications. But these new federal pricing benchmarks may give self-insured plans, insurers and PBMs more data and bargaining power to negotiate lower drug costs. There are also open questions for employers related to the impact of a DTC website on the drugs offered under their plans, including:

  • Will TrumpRx be available only to Americans without employer-provided prescription drug coverage, or will those with employer-provided coverage also have access to the website?
  • Will the use of TrumpRx increase demand for certain name-brand drugs and impact health plan drug pricing rebates and formularies?
  • Since one manufacturer has indicated that drugs purchased through its DTC website will not be subject to step therapy or prior authorization requirements, will this approach affect requirements related to prior authorization or step therapy for certain drugs under employer health plans?
  • How will the availability of discounted GLP-1s impact group health plans over time? Patients may turn to direct-to-consumer options for weight-loss GLP-1s, especially if their plans don’t cover these drugs or cost-sharing is higher than DTC prices. This shift creates uncertainty about where members will fill prescriptions and could challenge pharmacy benefit managers’ (PBMs) value in pricing and contract stability. Lower DTC prices could lead some employer plans to drop or avoid covering these drugs. Finally, it’s not clear whether access to a DTC website for discounted drugs will impact an individual’s eligibility to contribute to a health savings account, which would not be permitted if the DTC offering is considered “other coverage.” Overall, it remains to be seen whether employer health plans or their members will benefit from these discounts, and how the programs might affect plan formularies and coverage rules.

Transparency Initiatives: Drug Pricing and PBM Compensation

On February 25, 2025, President Trump issued an Executive Order directing the Departments of Health and Human Services, Treasury and Labor (the Departments) to implement and improve existing price transparency information, including meaningful disclosure of prescription drug pricing information.

These requirements were originally part of the Transparency in Coverage (TiC) rules issued during the first Trump Administration. The TiC rules require group health plans to post the negotiated prices and average net costs for prescription drugs in machine-readable files (MRF) on a public website. However, the MRF requirements for prescription drugs were delayed, and proposed regulations are expected sometime this fall.

What will determine usefulness for employers:

  • Consistent definitions: Clear, standardized terms for pricing, fees and rebates
  • Comprehensive scope: Inclusion of all relevant drugs, channels and remuneration
  • Usable format: Comparable, user-friendly data that supports decision-making

More information about prescription drug costs could benefit plan sponsors. However, poorly designed requirements might create compliance challenges without delivering useful data to help reduce drug expenses in employer health plans.

PBM Fee Disclosures

The Administration is also targeting pharmacy benefit manager compensation. An April 15 Executive Order instructs the Department of Labor to enhance employer transparency by proposing regulations that would require PBMs to more fully disclose both direct and indirect compensation they receive related to group health plans.

While increased disclosures can help plan sponsors more fully understand compensation streams for service providers, they may also present additional litigation risks for plan sponsors related to claims under ERISA for failing to consider certain types of revenue when selecting and monitoring service providers.

What Employers Can Do Now

While the full impact of these initiatives is still unfolding, there are practical steps employers can take today:

  • Stay informed: Keep up with announcements about MFN pricing, TrumpRx and transparency requirements
  • Engage vendors: Ask PBMs and other partners for detailed information about drug pricing and compensation to understand revenue, compensation and fees. Make sure contracts are clear and transparent.
  • Review plan design: As details become available, consider how direct-to-consumer options could affect your plan’s coverage, costs and member experience.
  • Prepare for compliance: Be ready to adapt to new reporting and disclosure requirements as regulations are finalized.

By staying informed, employers can position themselves to respond to prescription drug cost initiatives and continue providing valuable coverage to their workforce. Aon will continue to closely monitor changes in drug pricing, including significant developments and potential impacts on health plans.

This article was updated on November 19, 2025.

General Disclaimer

This document is not intended to address any specific situation or to provide legal, regulatory, financial, or other advice. While care has been taken in the production of this document, Aon does not warrant, represent or guarantee the accuracy, adequacy, completeness or fitness for any purpose of the document or any part of it and can accept no liability for any loss incurred in any way by any person who may rely on it. Any recipient shall be responsible for the use to which it puts this document. This document has been compiled using information available to us up to its date of publication and is subject to any qualifications made in the document.

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