America Finally Has Leverage on Drug Prices

For decades, politicians of both parties promised to lower prescription drug prices. They held hearings. They issued reports. They made speeches. Most failed - not because the problem was unclear, but because the system had one fatal flaw: the United States never used its leverage.

That has now changed.

President Donald J. Trump has done what politicians have been trying to do for years. He used the power of tariffs, trade leverage, and market access to force Big Pharma to do something it long resisted - lower drug prices for the American people.

Through Most-Favored-Nation (MFN) pricing, combined with tougher enforcement of competition and advertising rules, the Administration has shifted the balance of power. Drug companies are no longer negotiating against a divided government or endless process. They are responding to consequences.

This matters - not as a talking point, but as a structural change in how drug pricing works in the United States.

How were drug companies finally brought to the table? This outcome did not happen by politely asking pharmaceutical companies to “do the right thing.”

It happened because the Administration paired a clear demand with real leverage.

The demand was simple: Americans should not pay more for the same medicines than patients in other developed countries. For years, drugmakers charged U.S. patients two to four times what they charged abroad - because they could.

The leverage was unmistakable:

• Trade and tariff pressure tied to continued access to the U.S. market.
• Clear expectations communicated directly to corporate leadership and boards.
• A compliance pathway that offered certainty - if companies agreed to MFN pricing discipline.

This approach forced a decision. Boards could either continue defending the indefensible or accept a new pricing reality.

The result is not symbolic. Fourteen of the seventeen major pharmaceutical manufacturers targeted by the Administration - roughly 82 percent - have now agreed to MFN-style pricing commitments. That is a level of participation rarely achieved through voluntary reform alone.

This is what working a campaign promise looks like: not rhetoric, but execution.

What MFN pricing actually does is not complicated, and that is its strength.

If a drug company sells a medicine in Germany, Japan, or the United Kingdom at a lower price, the United States should not pay more for the same product. MFN pricing ties U.S. prices to the lowest price paid by comparable developed countries.

This reverses a long-standing and deeply unfair arrangement:

• Americans subsidized lower prices overseas.
• Drug companies recouped their profits primarily from U.S. patients.
• Seniors, cancer patients, and families with chronic illness paid the price.

MFN pricing changes the anchor. Once the benchmark moves, the entire pricing structure has to adjust.

While the Administration has not yet published a full, market-weighted list of drugs covered - a step it should take - the companies involved represent the largest share of brand-name spending and many of the highest-cost therapies. The potential impact is significant, especially as MFN commitments extend to future launches.

The Administration also deserves credit for understanding that drug prices are not driven by one actor alone.

High prices are the product of a system - one that allowed list prices, rebates, marketing, exclusivity, and weak enforcement to drift out of alignment with patient outcomes. That’s why MFN pricing is being paired with broader action:

• Tighter scrutiny of drug advertising, including full safety disclosure and digital enforcement.
• Increased oversight of market conduct, including exclusionary practices that delay competition.
• Pressure for transparency across the pricing chain.

This is not about tearing the system down. It is about rebalancing it - and that distinction matters.

Benefit Managers have become an easy political target. But oversimplifying the problem won’t fix it. PBMs can be part of the solution - if the rules are clear and enforced.

The next step is practical and achievable:

• MFN savings must show up at the pharmacy counter, not months later in plan accounting.
• Patient cost-sharing should be based on the lower MFN price, not inflated list prices.
• Rebates and fees should be transparent enough that employers and taxpayers can see whether savings are being passed through.

If MFN pricing becomes only a budgetary win for Medicare or plan sponsors, it will lose public trust. If it becomes a counter-top win - lower copays, lower coinsurance - it will endure.

How to get the remaining companies on board? With most major manufacturers already participating, the path forward is not radical. It is disciplined.

The Administration should institutionalize what worked:

• Define MFN clearly and publicly - Specify reference countries, pricing metrics, and update cadence so MFN cannot be gamed.
• Mandate point-of-sale savings - Patients should feel the benefit immediately.
• Publish a compliance scorecard - Not press releases - data. Which companies. Which drugs. What price reductions. What patient impact.
• Use certainty as the carrot - Companies value predictability. Stable rules and clear trade treatment reinforce compliance.
• Maintain a credible fallback - Voluntary agreements only work if holdouts know the alternative is worse.
• Accelerate real competition - MFN is a bridge, not the destination. Biosimilars, formulary parity, and enforcement against exclusionary practices are what keep prices down long-term.
• Finish cleaning up drug advertising - Enforce full safety disclosure - especially in digital and influencer marketing. Over time, policymakers should ask why the U.S. remains one of the only countries that allows widespread direct-to-consumer drug ads at all.

This moment is bigger than MFN pricing.

It is proof that government can still act pragmatically - using leverage where necessary, enforcement where justified, and markets where they work. It shows that the United States does not have to accept a system where Americans always pay more simply because they are Americans.

Lower drug prices are not a partisan victory. They are a patient victory.

President Trump has demonstrated that when the U.S. stops negotiating against itself, outcomes change. The responsibility now is to lock in those gains, make them transparent, and ensure they are felt where it matters most - at the pharmacy counter.

For the first time in a long time, lower drug prices are not just promised. They are within reach.