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President Donald Trump on Thursday sent formal letters to more than a dozen major pharmaceutical companies demanding they slash U.S. drug prices within 60 days — or risk federal action.
In a fiery post published on Truth Social, Trump revealed the letters, which instruct companies to offer their full range of medications to Medicaid patients at the same discounted prices charged in foreign countries, under what is known as the “most favored nation” rule.
He also insisted that companies “guarantee” pricing parity for Medicare, Medicaid, and private insurance patients going forward, especially for newly launched drugs. The letters further demanded drugmakers create direct-to-consumer options offering cheaper alternatives, and return “excess foreign profits” to American taxpayers.
“Make no mistake: a collaborative effort towards achieving global pricing parity would be the most effective path for companies, the government, and American patients,” Trump wrote. “But if you refuse to step up, we will deploy every tool in our arsenal to protect American families from continued abusive drug pricing practices.”
It remains unclear whether Trump — currently seeking a return to the White House — has the legal authority to unilaterally compel pharmaceutical companies to cut prices without action from Congress. Experts caution that the move, while dramatic, could hit legal and political roadblocks.
“It may take more than a tough letter from the President to motivate the pharmaceutical industry to drop their prices,” said Tricia Neuman, director of the program on Medicare policy at KFF. “The voluntary approach hasn’t worked so far… Drug prices tend to go down when compelled by law or in response to competition.”
Trump’s letters were addressed to 17 major drugmakers including Pfizer, Merck, Eli Lilly, Johnson & Johnson, GSK, Amgen, Novo Nordisk, and Novartis. NBC News reached out to all the companies for comment. Novo Nordisk responded by saying it is “focused on improving patient access and affordability.” Eli Lilly acknowledged it was reviewing the letter and directed inquiries to the Pharmaceutical Research and Manufacturers of America (PhRMA), which did not immediately respond.
Prescription drug costs have become a central issue in U.S. politics. According to the RAND Corporation, Americans pay up to 10 times more for medications than citizens in peer nations. A recent KFF poll found that more than three-quarters of U.S. adults consider drug prices unaffordable.
In May, Trump signed an executive order aimed at reviving his “most favored nation” pricing strategy, which failed to take effect during his first term. That order instructed federal health agencies to re-implement the rule as part of broader efforts to cut drug costs.
While Trump pushes companies to act voluntarily, his administration could also benefit from Medicare drug price negotiations authorized by the Inflation Reduction Act — a Biden-era law that Trump has previously criticized. The first round of negotiated prices, affecting 10 of the most expensive medications, is projected to save Medicare $6 billion starting in 2026.
Despite industry resistance, Trump’s letter campaign signals a renewed focus on prescription costs, an issue that polls consistently rank among Americans’ top healthcare concerns. Whether his threats lead to real reform — or legal battles — remains to be seen.
