Executive order sets a most-favored-nation drug pricing target

President Trump signed an executive order on May 12, 2025 titled "Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients," directing his administration to bring what Americans pay for prescription drugs in line with prices paid in other developed nations ^[2][3]. The order promised reductions of up to 59% ^[1], and it became the legal and political framework for the GLP-1 pricing agreements announced in November 2025 and for the TrumpRx website.

What the order actually did

The order did not set prices by itself. It directed the Secretary of Health and Human Services to communicate most-favored-nation (MFN) price targets to drug manufacturers, and, if companies did not make significant progress toward those prices, to propose a plan for rulemaking ^[3]. It also told HHS to help manufacturers set up direct-to-consumer purchasing programs for products sold at MFN prices ^[3] — the seed of what later became TrumpRx.

The follow-through came in stages. On July 31, 2025, the president sent letters to leading manufacturers spelling out steps to match the lowest price offered in other developed nations ^[2][3]. On September 30, 2025, the administration announced its first deal, with Pfizer, covering state Medicaid access to MFN prices, MFN pricing on Pfizer's new medicines, and deep discounts for patients buying directly ^[3]. The same day, officials announced TrumpRx, a direct-to-consumer website planned for launch in "early 2026" ^[3].

How GLP-1 prices were affected

The November 6, 2025 announcement applied the framework to the two best-known obesity and diabetes drug makers. Under the agreements, the price of Ozempic would fall from $1,000 per month and Wegovy from $1,350 per month to $350 when bought through TrumpRx ^[2]. Both are semaglutide, made by Novo Nordisk. Zepbound (tirzepatide, from Eli Lilly) and orforglipron, Lilly's oral GLP-1, would fall from $1,086 per month to an average of $346 ^[2]. If the FDA approved a Wegovy pill or similar oral GLP-1s in either company's pipeline, the initial dose would be priced at $150 per month ^[2].

The deals also set Medicare prices of $245 for Ozempic, Wegovy, Mounjaro and Zepbound, with state Medicaid programs getting access at those prices and Medicare beneficiaries paying a $50 monthly copay ^[2]. The White House said the arrangement would let Medicare cover Wegovy and Zepbound for people with obesity and related conditions for the first time ^[2]. Novo committed an additional $10 billion in US manufacturing, and Lilly announced at least $27 billion ^[2].

TrumpRx went live on February 5, 2026 with more than a dozen manufacturers participating ^[1]. The site does not sell drugs; it links out to company websites, and purchases require cash payment — health insurance is not accepted, which conflicts with some manufacturers' own direct-to-consumer programs that do take insurance ^[1]. Reported GLP-1 prices matched the November figures, with an initial price of $150 for an FDA-approved oral GLP-1 ^[1]; a separate roundup listed the lowest dose of orforglipron starting at $149 ^[1].

Why it matters for patients

The order reset the reference point for GLP-1 cash prices. For someone without coverage, the difference between a $1,350 list price and a $350 cash price is large. But the savings are tied to paying cash, which means insured patients could end up spending more out of pocket than they would using their benefit, especially where a covered option or a generic is cheaper ^[1]. Health policy experts have also cautioned that savings may not arrive immediately or at all, that full details of the manufacturer deals may never be public, and that it is unclear whether the agreements survive after this administration ^[1]. The total effect on Medicaid programs remains uncertain, and some analysts warn of reduced biotech investment, particularly at small and midsize firms ^[1].

What happens next

The order's enforcement path — rulemaking if manufacturers fall short — has not been used publicly so far; the administration has instead announced company-by-company deals, five of them between September 30 and early November 2025 ^[2]. Whether MFN pricing extends beyond cash-pay channels into insured coverage is not yet known ^[3].