Trump's 2025 Order Aims to Slash US Drug Costs: Will Patients Actually See Savings?

On April 15, 2025, President Donald Trump signed an executive order aimed at tackling the soaring cost of prescription drugs in the United States. The directive, which builds on efforts from his first term, promises to lower prices for millions of Americans, particularly seniors on Medicare and low-income patients. It’s a response to a problem that hits wallets hard: the U.S. spends more per capita on pharmaceuticals than any other developed nation, with prices often double those in countries like Canada or the UK.

The order directs the Department of Health and Human Services to enhance the Medicare Drug Pricing Negotiation Program, streamline payments for certain drugs, and provide steep discounts on life-saving medications like insulin and epinephrine. It also pushes for greater transparency in the pharmaceutical supply chain and encourages competition through generics and biosimilars. For patients struggling to afford medications, the plan sounds like a lifeline. But the road to lower prices is fraught with complexities, from regulatory hurdles to industry pushback.

At the heart of the executive order is an effort to strengthen the Medicare Drug Pricing Negotiation Program, launched under the 2022 Inflation Reduction Act. The program allows the government to negotiate prices for high-cost drugs covered by Medicare, a move that began with 10 drugs in 2024 and expanded to 15 more in 2025, including treatments for diabetes and cancer. The Centers for Medicare & Medicaid Services estimates that the initial negotiations could have saved $6 billion in 2023, cutting spending on those drugs by 22%.

Trump’s order seeks to expand the number of drugs eligible for negotiation and align Medicare payments with the prices hospitals actually pay, which can be up to 35% lower than current rates. It also aims to standardize payments for treatments like chemotherapy, potentially reducing costs by as much as 60% depending on where patients receive care. While these steps could ease the financial burden on seniors, the new prices won’t take effect until 2027, and pharmacies worry about cash flow disruptions from delayed reimbursements.

Some experts caution that the program’s design, which allows biologics to be negotiated only after 11 years compared to seven for small molecule drugs, may skew drug development toward more expensive biologics. The administration is exploring ways to harmonize these timelines, but pharmaceutical companies argue that negotiations could stifle innovation. Lawsuits challenging the program’s legality add another layer of uncertainty.

The executive order also doubles down on promoting generics and biosimilars, which are often far cheaper than brand-name drugs. Generics, chemically identical to their branded counterparts, can cost up to 80% less, while biosimilars, which are similar to complex biologic drugs, typically offer 15-40% savings. With the global generic drug market expected to hit $1 trillion by 2025, the administration wants to streamline approvals and boost adoption to drive competition.

Another piece of the puzzle is drug importation. The order instructs the FDA to expedite state programs that allow importing lower-cost drugs from countries like Canada. Florida received approval for such a program in 2023 but has yet to start imports, and other states face logistical and regulatory barriers. Pharmaceutical manufacturers and the Canadian government have raised concerns about safety and supply chain risks, and a potential federal investigation into tariffs on imported drugs could complicate cost savings.

For patients, the promise of cheaper generics, biosimilars, and imported drugs is appealing, but the reality is messier. Rebate deals favoring brand-name drugs and complex approval processes for biosimilars slow progress, while tariffs could inadvertently raise prices. The administration’s push for domestic manufacturing adds another wrinkle, as shifting production to the U.S. would take years and significant investment.

Pharmacy Benefit Managers (PBMs), the intermediaries who negotiate drug prices and manage formularies, are a key target of the order. The three largest PBMs—CVS Caremark, Optum Rx, and Express Scripts—control much of the market and face growing scrutiny for practices like steering patients to affiliated pharmacies and opaque rebate deals. A 2025 Federal Trade Commission report highlighted how PBMs often favor their own pharmacies, and states like Alabama are passing laws to ensure fair reimbursement for independent pharmacies.

The executive order calls for better disclosure of PBM fees and reforms to make the drug supply chain more transparent and competitive. This builds on earlier efforts to pass manufacturer discounts directly to patients rather than PBMs. While these changes could lower costs, critics argue that PBMs also drive down prices through bulk negotiations, and heavy-handed regulation might disrupt the system. Independent pharmacies, already closing at alarming rates, hope for relief but worry about the pace of change.

For everyday Americans, the executive order’s success hinges on tangible results. The plan to lower insulin to as little as $0.03 and epinephrine to $15 for low-income and uninsured patients could be a game-changer for those with chronic conditions. Standardizing Medicare payments and expanding negotiations promise relief for seniors, who often face crippling out-of-pocket costs. But with savings delayed until 2026 or later, many patients won’t feel the impact right away.

The broader push for transparency and competition could reshape the drug market, but it’s not without risks. Industry groups warn that aggressive price controls might limit research into new treatments, while pharmacies fear financial strain from reimbursement changes. On the flip side, patient advocates argue that the current system prioritizes profits over access, and any step toward affordability is welcome. The challenge lies in balancing cost reductions with innovation and access, all while navigating a web of legal, regulatory, and political obstacles.