Fact Sheet: President Donald J. Trump Announces Largest Developments to Date in Bringing Most-Favored-Nation Pricing to American Patients

In this context, a “most‑favored‑nation (MFN) price” is defined as the lowest net price that a brand‑name drug sells for in a selected group of other rich countries, and U.S. prices are then tied to that level.

Key points:

• The White House describes MFN pricing as bringing U.S. prices “in line with the lowest prices paid by other developed nations.”[1][2]
• Policy explainers on the Trump MFN initiative say the reference group is a basket of wealthy countries (the other G7 nations—Canada, France, Germany, Italy, Japan, the U.K.—plus countries like Switzerland and Denmark, and more broadly OECD countries with per‑capita GDP at least 60% of the U.S.).[3]
• The MFN benchmark is based on net price, meaning the final price after rebates and discounts in those countries, not just the public list price.[3][4]

So, in simple terms: officials look at what comparable countries actually pay after discounts for a given drug, identify the lowest of those prices, and that becomes the MFN price that U.S. Medicaid programs (and, for some drugs, TrumpRx direct‑purchase offers) are supposed to match or beat.

TrumpRx is a federal government website (TrumpRx.gov) that lists discounted prices for certain brand‑name drugs and then sends patients to the drug company’s own site to buy directly.

How it works for patients:

• TrumpRx.gov itself does not sell or ship medicines; it’s a price‑search portal.[5][6]
• A patient searches for a drug on TrumpRx.gov; if that drug is in a Trump‑administration deal, the site shows the discounted “MFN‑based” cash price and provides a link to the manufacturer’s direct‑to‑consumer platform.[5][6][7]
• The patient then completes the purchase on the manufacturer’s site, typically paying cash out‑of‑pocket (not through insurance). These payments usually do not count toward insurance deductibles or out‑of‑pocket limits.[6]
• The White House fact sheets and TrumpRx site emphasize that the discounts can be large (e.g., Repatha $573→$239, Reyataz $1,449→$217, Epclusa $24,920→$2,425 when bought via TrumpRx).[1][8]

In short: patients access TrumpRx via TrumpRx.gov, look up their medicine, and—if it’s covered—are redirected to a company website to buy the drug at a discounted cash price.

For these MFN deals, state Medicaid programs do not have to negotiate individually with each company; the agreements are structured so MFN prices apply nationwide through the Medicaid drug‑rebate framework, but states will likely need some technical and billing updates to implement them.

Evidence:

• The Pfizer and multi‑company White House fact sheets state that the agreements “will provide every State Medicaid program in the country access to MFN drug prices” on the participating companies’ products.[1][2]
• The American Hospital Association summary of the Pfizer deal likewise says the agreement “will provide every state Medicaid program in the country access to MFN drug prices on Pfizer products,” treating this as a uniform national change, not an opt‑in program.[9]
• Analyses of the Pfizer MFN deal describe it as Pfizer offering its portfolio at MFN‑benchmarked pricing for Medicaid beneficiaries beginning in 2026, applied through existing rebate and pricing systems.[10]

However, the detailed operational terms (exact rebate formulas, whether any state plan amendments are required, etc.) are not public. Based on what is known, access is intended to be automatic and nationwide, with any implementation work handled through CMS, manufacturers, and state Medicaid agencies rather than state‑by‑state bargaining.

“Repatriate increased foreign revenue” means that if a company earns more money abroad on existing drugs because U.S. trade policy has pushed other countries to accept higher prices, it must bring that extra income back to the United States and use it for U.S.‑focused purposes (like domestic investment or lower U.S. prices), rather than keeping it overseas.

What is known:

• Multiple White House fact sheets (Pfizer, AstraZeneca, the nine‑company deal) state that participating firms “must repatriate increased foreign revenue on existing products” realized as a result of the administration’s “America First” trade policies, for the benefit of American patients.[1][2][11]
• Legal and policy summaries of the Pfizer MFN agreement describe this as requiring Pfizer to bring back and reinvest additional foreign earnings generated by higher ex‑U.S. prices, with those funds to support U.S. R&D, manufacturing, and price reductions.[12][13]

What is not publicly specified:

• The exact formula for calculating how much foreign revenue counts as “increased,” how quickly it must be brought back, or how strictly use of those funds will be monitored.
• The enforcement mechanics; outside analyses indicate these provisions sit inside confidential contracts and are backed mainly by leverage such as tariff threats or loss of tariff exemptions, rather than by a specific statute with defined civil penalties.[12][13]

So, in practice, repatriation is a promise to route extra foreign profits back into the U.S. economy and pricing, but the detailed accounting rules and enforcement tools are not disclosed.

The Strategic Active Pharmaceutical Ingredients Reserve (SAPIR) is a federal stockpile of active pharmaceutical ingredients (APIs) for critical medicines, intended to give the U.S. a six‑month buffer of key drug components in case of shortages or supply‑chain shocks.

Structure and purpose:

• The August 2025 executive order and White House fact sheet explain that SAPIR was created in Trump’s first term to stockpile APIs, which are generally cheaper and have longer shelf lives than finished drugs, to reduce dependence on foreign suppliers.[14][15]
• The order directs HHS’s Assistant Secretary for Preparedness and Response (ASPR) to: identify ~26 “critical drugs,” ready the SAPIR repository, and obtain and store a 6‑month supply of APIs for those drugs, preferring domestically made APIs; then develop a plan to extend this to an updated list of 86 essential medicines and to open a second SAPIR site.[14][15]

How donated ingredients are stored and used:

• Under the MFN agreements, companies donate specific quantities of APIs (e.g., GSK albuterol, BMS apixaban, Merck ertapenem) “to the Strategic Active Pharmaceutical Ingredients Reserve (SAPIR)” where they are added to the national stockpile.[1]
• EO 14336 requires ASPR to prepare and maintain SAPIR repositories capable of storing these APIs and to manage them as a rotating reserve—maintaining a six‑month supply and using procurement tools to refresh stocks over time.[14]
• In an emergency or shortage, HHS can release APIs from SAPIR to contracted manufacturers (such as domestic API and finished‑dose producers) to be turned into finished medicines for hospitals or federal stockpiles.[16][17]

Public documents do not spell out detailed warehousing locations or rotation protocols, but they make clear that SAPIR is a centralized, HHS‑managed API stockpile designed to support production of essential medicines during disruptions.

The MFN arrangements announced so far are voluntary agreements negotiated between the Trump administration and individual drug companies, typically documented in confidential contracts or memoranda of understanding. They are not statutory price controls, and specific penalty clauses for non‑compliance have not been made public.

What can be said from public information:

• The White House consistently describes these as “agreements” that manufacturers have “signed” with the administration to provide MFN pricing, Medicaid access, investments, and TrumpRx discounts.[1][2][11]
• Legal and industry analyses characterize the Pfizer deal and subsequent agreements as voluntary, bilateral arrangements made under pressure of threatened tariffs and possible future regulation, rather than as rules imposed by Congress or by CMS through formal rulemaking.[6][12][18]
• The administration’s leverage is mainly political and trade‑related: for example, Pfizer and others reportedly received temporary exemption from 100% tariffs on imported branded drugs in exchange for cooperating, with the implicit risk that tariffs or stricter regulation could be imposed if they failed to honor commitments.[6][12][18]

Because the contracts themselves are confidential, the exact legal remedies (e.g., financial penalties, termination rights) for breach are not publicly known. From the available record, enforcement appears to rely primarily on the ability of the U.S. government to withdraw tariff relief, pursue new tariffs or investigations, or walk away from the agreements, rather than on a specific, public schedule of fines.

The U.S.–U.K. agreement does not directly set a single 25% price hike on each new drug. Instead, it changes the U.K.’s pricing rules so that, overall, the net prices the NHS pays for new medicines rise by about 25%, mainly by loosening cost‑effectiveness thresholds and scaling back rebate claw‑backs.

Mechanism, based on public documents:

• The U.S. Trade Representative and White House say the U.K. has agreed to “increase the net price it pays for new medicines by 25%” and to “reverse the decade‑long trend of declining NHS expenditures on innovative, life‑saving medicines.”[1][19]
• The USTR release explains that the U.K. will ensure higher prices are not “materially eroded” by portfolio‑wide rebates under its Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG); the repayment (rebate) rate will be cut to 15% in 2026 and kept at or below that level for the life of the scheme.[19]
• Reporting in U.K. and industry media notes that this is being implemented largely by raising the cost‑effectiveness threshold used by NICE (the body that assesses whether new drugs are “value for money”) and by easing overall VPAG budget caps, which together allow companies to charge more while facing lower claw‑backs.[20][21]

In sum: by relaxing NICE’s thresholds and reducing mandatory rebate rates under VPAG, the deal allows manufacturers to obtain higher approved list prices and keep more of that revenue, which U.S. and U.K. officials estimate will raise average net spending per new drug by roughly 25% compared with the previous system.