The Trump administration is barreling ahead with a flashy new plan it claims will slash prescription costs – just as the federal government has begun day one of its shutdown. Starting today, any imported brand-name drug not made on U.S. soil faces a 100% tariff. President Trump is also touting a “Most Favored Nation” (MFN) drug pricing scheme that sounds like common sense: why shouldn’t Americans pay what other wealthy countries pay? Other countries can enforce those lower prices because they have centralized health systems with strict regulation. The U.S. does not. Trying to import foreign price controls without importing the systems that make them work is not reform — it’s incoherent policy. Economists have warned that this approach risks backfiring: discouraging innovation, sparking trade disputes, and even driving up costs abroad, while doing little to fix the root causes of high prices here at home.
And in a move straight out of a retail playbook, the White House is launching “TrumpRx,” a government-run website where Americans can buy medications directly. On paper, my first thought was “Oh wow, we’re trying socialism!” But this is really just political theater rather than a real fix for sky-high drug costs. TrumpRx will likely be about as useful as a degree from Trump University.
Trump’s Three-Pronged Plan
Starting today, the United States is imposing a 100% import tax on pharmaceutical drugs. Trump announced this via Truth Social, declaring that only drugmakers actively building U.S. manufacturing plants will be exempt. “’IS BUILDING’ will be defined as, ‘breaking ground’ and/or ‘under construction,’” Trump stated. The administration justifies this under a “national security” trade law (Section 232), similar to tariffs on steel, aluminum (and now even on wood products like kitchen cabinets!).
Simultaneously, the White House struck their “Most Favored Nation“ deal with Pfizer to match the lowest drug prices found in any developed nation. Under the September 30 agreement, Pfizer will charge Medicaid no more than the lowest price it offers abroad and extend those prices to new drugs.
The third element is TrumpRx, a new government-run website allowing Americans to purchase certain drugs directly at prices negotiated by the government. By cutting out middlemen like insurers or pharmacy benefit managers, the White House argues TrumpRx will pass savings directly to patients, though it remains unclear which drugs will be available or how it works for Medicare and privately insured patients.
Critical Questions and Ambiguities
On paper, the numbers look massive: U.S. pharmaceutical imports are over $200 billion annually. Meanwhile, companies like Eli Lilly are pledging a $6.5 billion plant in Houston, and Novo Nordisk is committing $4.1 billion to new capacity in North Carolina But Trump’s plan is riddled with contradictions.
The tariff rule is a black box. Trump’s post doesn’t specify whether drugmakers with existing U.S. plants would be exempt, whether exemptions cover all their products or only drugs manufactured at U.S. sites, or whether companies expanding facilities qualify. Many popular brand-name drugs are primarily manufactured overseas: Botox and cancer drug Keytruda are made in Ireland.
The Pfizer deal is carefully crafted political theater.There’s no independent way to verify prices, and the agreement barely touches most Americans. Employer-based coverage and Medicare — the real bulk of the market — are left out. Worse, the direct-purchase discounts are a gimmick. Almost nobody buys medicine straight from manufacturers. It’s like advertising half-price cars, but only if you pick them up at the assembly line in Detroit.
The bottom line: the policy is murky, the benefits are years away at best, and the immediate effect is confusion, higher costs, and corporate loopholes.
Who Bears the Costs?
Well, the answer is what you would expect. “Ultimately, tariffs are taxes on patients,” said Dr. Aaron Kesselheim, a professor at Harvard Medical School, “and to the extent that drug companies see increases in cost due to tariffs, they will pass those costs on to patients.” Whether through higher copays or insurance premiums, the costs will flow downstream. The government itself, as the largest purchaser of prescription drugs through Medicare, Medicaid, and the VA, will face the largest price increases.
While generic drugs (over 90% of U.S. prescriptions) are exempt, it’s precisely the brand-name, patent-protected drugs that lack generic substitutes and command sky-high prices that are now subject to double taxation. Will the tariffs actually spur domestic manufacturing? Unlikely, experts say. “It is somewhere between two years and five years to get new production facilities built,” noted Rena Conti, an associate professor at Boston University, “and it can be in the millions of dollars.” Even retooling existing facilities takes 18 to 36 months.
This timeline exposes a fundamental contradiction in Trump’s strategy. The policy creates immediate pain for patients while any potential benefits lie years in the future, long after the next election cycle. Meanwhile, pharmaceutical companies face perverse incentives: they can announce splashy construction projects that provide immediate exemptions even if facilities won’t produce a single pill for half a decade.
This creates a tale of two realities. On one hand, the administration crows about saving Americans money on drugs. On the other, its brinksmanship over the budget is actively harming American healthcare and economic stability. In fact, part of the funding fight was about healthcare: Democrats in Congress have been pushing to extend Affordable Care Act subsidies (to prevent a spike in premiums) and to stop GOP proposals for cuts to health programs. They argue Trump is “not doing enough to lower health care prices,” even as he grandstands on Pfizer’s price cuts. Vice President JD Vance, instead accuses Democrats of “threatening to shut down the government to subsidize health care for illegal aliens” – a claim meant to distract and inflame, not illuminate. It’s a toxic political standoff, and American patients are caught in the middle.
Amid this circus, Congressional leadership seems largely asleep at the wheel. House Democrats talk a good game about protecting the Affordable Care Act and tout past achievements like empowering Medicare to negotiate drug prices. Yet where is the full-throated, unified response to Trump’s tactics? Beyond a few press releases and social media jabs, they’ve been reactive rather than proactive. They should be seizing this moment to expose the flaws in Trump’s approach and champion a better path—instead, they’re hitting the snooze button.
To be fair, some Democrats do see through the gimmickry. Democrats have rightly pointed out that they delivered tangible savings – like a $35 insulin cap for seniors and the first round of Medicare price negotiations – while Trump’s trade-war tactics could backfire. There’s a valid argument that Trump is taking Americans hostage with tariffs and using executive muscle where real bipartisan lawmaking is needed. Recent Blueprint polling shows that the most effective message for getting the public to blame the GOP for the shutdown is simple: health care prices are going up.
Government processes? Most folks tune out—that’s for policy nerds who read blogs like ours for fun (and yes, we proudly salute you very cool people).
But their ears perk up when they understand how it impacts their wallet, and who is to blame.
Image Credit: Blueprint Polling
The problem is, these Democratic critiques are coming in scattered shots. There hasn’t been a galvanizing, united front to offer Americans a clear alternative vision on drug affordability at this moment. The House minority could be out there every day highlighting American patients’ stories, what could happen when we raise these premiums, the mother rationing her insulin, the senior cutting pills in half – and demanding systemic fixes rather than Trump’s “splashy but suspect” maneuvers. Instead, we mostly see the usual partisan impasse and a minority party content to let Trump have the airtime on this issue. It’s a missed opportunity to stand up for the majority of Americans who desperately need relief from medical costs.
In the coming days, the focus on the Hill will likely shift to blame – who “won” or “lost” the shutdown standoff, which politicians scored points. But let’s keep our eyes on what actually matters: whether Americans can afford and access the medicine they need to live. Right now, that fundamental promise is imperiled by political gamesmanship. This moment demands moral clarity: it is wrong for our leaders to allow critical healthcare needs to become hostages of their feuds and ambitions. The government’s doors need to reopen, and our drug pricing policies need a dose of sanity. Anything less is an abandonment of the very people public service is meant to serve.