– In a dramatic escalation of the fight over U.S. drug prices, President Donald Trump’s administration has given the pharmaceutical industry a stark ultimatum: lower prescription costs for American patients within 60 days or face aggressive federal intervention.
The White House announced this sweeping demand through 17 letters sent directly to the CEOs of the world’s largest pharmaceutical companies. The message, read aloud by Press Secretary Karoline Leavitt during a briefing, left little room for negotiation.
“If you refuse to step up, we’ll deploy every tool in our arsenal to protect American families from continued abusive drug pricing practices,” the letters warned.
The move marks one of the most ambitious attempts yet by any U.S. administration to take on pharmaceutical giants, signaling that the president intends to make prescription affordability a defining policy battle in his second term.
A Push for “Most-Favored-Nation” Pricing
At the heart of the ultimatum is Trump’s insistence on “Most-Favored-Nation” (MFN) pricing. The principle is simple: Americans should not be paying more for the same drugs than patients in other wealthy countries.
Currently, U.S. patients often pay two to three times as much for life-saving medications compared to Europe or Canada. According to federal health data, the United States spends more per capita on prescription drugs than any other nation. Nearly one in four Americans admit to rationing or skipping prescriptions due to costs.
Trump’s MFN policy, outlined in an executive order signed in May, demands that drugmakers extend their lowest global price to U.S. markets. The administration’s letters expand this requirement to include:
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Medicaid recipients – ensuring the poorest Americans benefit directly.
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Newly launched drugs – requiring companies to set initial prices in line with their cheapest global rate.
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Revenue repatriation – calling on firms to return profits from inflated foreign prices to support American patients.
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Direct purchasing options – allowing patients to buy medications at MFN rates, bypassing middlemen like pharmacy benefit managers (PBMs).
“Global freeloading ends with this administration,” Trump wrote in his letter to Eli Lilly’s CEO, David Ricks.
Industry Reaction: Shock, Resistance, and Strategic Caution
The pharmaceutical industry responded with a mix of alarm and guarded statements. Stocks in several major firms—including Pfizer, Merck, and Johnson & Johnson—dipped briefly following the announcement, though most rebounded within hours. Analysts suggested markets were betting on the industry’s ability to resist or dilute the reforms.
Industry lobbyists argue that tying U.S. drug prices to international benchmarks could cripple innovation, warning it would reduce funding for research and development of new treatments.
“The American system is what fuels medical breakthroughs,” one pharmaceutical executive said anonymously. “If our pricing flexibility disappears, so does the next generation of cures.”
Yet critics counter that this line has been used for decades to justify runaway profits. According to federal data, the pharmaceutical sector consistently ranks among the most profitable industries in the United States, often posting double-digit margins.
Historical Context: Trump’s Long Fight with Big Pharma
This is not Trump’s first battle with the drug industry. During his first term, he launched initiatives aimed at price transparency and international reference pricing, but most were either watered down or struck down in court.
The difference this time is both political capital and public pressure. Trump won reelection in 2024 promising to slash drug costs, and soaring prices have remained a top concern for voters across party lines. Polls show overwhelming bipartisan support for government action to curb costs.
The administration is also framing the issue as a matter of economic fairness. Trump has repeatedly claimed that American patients are “subsidizing” low prices abroad, where governments negotiate aggressively with drugmakers while U.S. consumers are left to pay the balance.
“Other nations negotiate, and they get a good deal. We don’t negotiate—we pay whatever Big Pharma asks,” Trump said in a recent rally. “That ends now.”
Why 60 Days? A Calculated Deadline
The 60-day window is designed to force immediate responses while aligning with the fall legislative calendar. By setting a hard deadline, the White House increases pressure on both industry executives and members of Congress.
If drugmakers fail to present binding commitments, the administration has hinted at multiple options:
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Regulatory changes through the Department of Health and Human Services (HHS).
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Direct government negotiations on behalf of Medicare and Medicaid.
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Expanded executive orders tying pricing to federal purchasing power.
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Potential trade measures against companies deemed to be exploiting U.S. markets.
The ultimatum also sets up a potential legal showdown. Industry groups are already preparing lawsuits arguing that MFN pricing violates constitutional protections and international trade rules.
Political Stakes: A High-Risk, High-Reward Strategy
For Trump, the move is both politically risky and potentially rewarding. Successfully cutting drug prices would deliver a tangible benefit to millions of Americans, strengthening his populist brand.
But failure—or even the perception of capitulation to Big Pharma—could erode trust among his base.
Democrats, traditionally more supportive of drug pricing reforms, face a tricky political choice. Many support the idea of lowering costs but are reluctant to hand Trump a political victory. Some progressive lawmakers are already pushing for Medicare for All–style negotiations that go beyond Trump’s MFN framework.
Meanwhile, Republican lawmakers are split. Fiscal conservatives worry about government overreach, while populist conservatives embrace the plan as a way to stand up to corporate power.
Global Implications: Ripples Beyond U.S. Borders
If the policy is enforced, the ripple effects could be felt worldwide. Drugmakers may respond by raising prices abroad to offset U.S. cuts, creating tension with European and Canadian governments.
Health economists also warn of a possible two-tiered system: companies could prioritize releasing new drugs in countries willing to pay higher launch prices, delaying access for others.
However, supporters argue that forcing international parity would finally put American patients on equal footing, ending decades of lopsided pricing.
The Broader Healthcare Puzzle
Drug pricing is only one piece of the U.S. healthcare cost puzzle, but it is among the most visible. Americans routinely encounter sticker shock at the pharmacy counter, making it a powerful political issue.
Experts say real reform will also require addressing structural inefficiencies, such as:
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The role of pharmacy benefit managers (PBMs), who negotiate rebates behind closed doors.
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Patent loopholes that extend monopolies on popular drugs.
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Limited competition in the generic and biosimilar markets.
The Trump administration has signaled it may target PBMs next, accusing them of pocketing rebates that should lower costs for patients.
What Comes Next?
The next two months will be decisive. Pharmaceutical companies are expected to lobby aggressively, both behind the scenes in Washington and publicly through advertising campaigns warning of the risks of “price controls.”
At the same time, consumer advocacy groups are preparing to rally in support of the ultimatum, highlighting personal stories of families crushed by medical bills.
Trump, known for his combative style, appears ready for a public showdown. “We’re not asking,” he said during a recent event. “We’re telling them: lower your prices, or we’ll do it for you.”
Conclusion: A Defining Battle
The administration’s 60-day ultimatum sets the stage for one of the most consequential battles between the U.S. government and the pharmaceutical industry in modern history.
For patients, the outcome could mean hundreds—or even thousands—of dollars in annual savings. For drugmakers, it represents an existential threat to their current business model.
The fight over drug prices has simmered for decades. Now, with a firm deadline and the weight of the presidency behind it, the battle is moving to the forefront of national politics.
Whether this ultimatum produces meaningful reform or dissolves into another round of stalemate will shape not only the cost of medicine in America but also the balance of power between government and industry for years to come.