At least five drug companies have signed on to the Trump administration’s plan to facilitate direct-to-consumer (DTC) purchasing programs at most-favored-nation (MFN) pricing for prescription treatments for medical conditions including diabetes, obesity, migraines and infertility.

In some cases, the agreements include pricing for glucagon-like peptide-1 drugs (GLP-1s), the weight loss medications that have challenged employer health plan budgets.

While the recent announcements don’t directly apply to commercial insurance or group health plans, some say that by having transparent prices to reference, employer-sponsored plan prices for these medications will decrease eventually. Others say the drug companies could try to recoup costs by charging the employer/commercial payers more for the same product. “Some speculate that the price improvements offered to the government will also make their way to group health plans. Others believe the manufacturers will look to make up for these price concessions with price increases (or lower rebates) for group health plans,” according to Segal.

The effort could have a wide impact on drug pricing, with ripple effects impacting pharmacies, plan sponsors and pharmacy benefit managers (PBMs) in different ways. This blog highlights news coverage to date and uncertainties for employers and group health plan sponsors to consider as we await further developments.

Executive Order and Drug Manufacturer Agreements

President Trump’s May 12, 2025 executive order directed that pharmaceuticals in the U.S. be sold at the lowest price charged in similar developed countries, which the administration refers to as MFN pricing. The Secretary of Health and Human Services was directed to facilitate DTC purchasing programs that enable Americans to purchase medications directly from drug manufacturers at MFN prices. Facilitation is expected as early as January 2026 via TrumpRx, a single website where consumers can search for medication and see a list of direct-purchase options and prices.

Drug manufacturers EMD Serono, AstraZeneca, Pfizer, Eli Lilly and Novo Nordisk struck pricing agreements with the Trump administration. The deals are complicated, and details could remain confidential, according to Fierce Pharma. Eli Lilly and Novo Nordisk will guarantee MFN prices on all new medicines that they bring to market and provide Medicaid program access to MFN drug prices on their products, per the White House’s fact sheet. Because Medicare will buy their GLP-1 treatments, for potentially millions of Medicare beneficiaries, the Novo Nordisk and Eli Lilly deals could have a wider impact on GLP-1 affordability compared with the other manufacturer agreements that didn’t address Medicare pricing. Eli Lilly’s press release said the “scope of the agreement does not include pricing obligations in the commercial channel.”

GLP-1 Price Reductions

The White House fact sheet listed discounts off of list prices that Eli Lilly and Novo Nordisk agreed to for GLP-1 weight loss drugs paid for by Medicare, Medicaid or directly to consumers.

• The prices of Ozempic® and Wegovy® will fall from $1,000 and $1,350 per month, respectively, to $350 when purchased through TrumpRx.
• The price of Zepbound® will fall from $1,086 per month to an average of $346 when purchased through TrumpRx.
• In the event that the Food and Drug Administration (FDA) later approves GLP-1 pill versions in each company’s pipeline intended to be taken orally, the initial dose of those drugs will be priced at $150 per month through TrumpRx.

The Medicare prices of Ozempic, Wegovy, Mounjaro® and Zepbound will be $245 per month. Based on the fact sheet, a Medicare beneficiary would pay $50 per month, and Medicare would pay the remainder of the $245.

Who Will Access TrumpRx?

Analysis from attorneys and consultants indicates that the announcement doesn’t directly impact employer group health plans. Will TrumpRx be available only to people without employer-provided prescription drug coverage? Below is what government officials have said to news sources.

• “In response to a question during the announcement at the White House about helping people with insurance access the drugs at lower prices, Director of Medicare Chris Klomp said, ‘Many Americans receive their insurance through the commercial markets. The companies have committed to ensure that, at worst, prices are at MFN on GLP-1s and are committed to continue to negotiate those prices down based on volume just as they do in any other instance,’” as reported by Lauren Clason in a Bloomberg Law article titled TrumpRx Weight-Loss Drug Deal Raises Questions for Insurance on November 6, 2025.
• Also reported in Bloomberg Law’s article, “While the Most Favored Nation framework applies to federal programs, manufacturers have voluntarily committed to extend those same savings to the commercial market wherever possible,” HHS spokesperson Andrew Nixon said in a statement.
• “It’s true that insured Americans may pay less for drugs than the TrumpRx cash price in some cases, a White House official told Axios. But the arrangement could prod more employers to integrate direct-to-consumer drug purchasing into their health plans, the official said,” according to Patients May Not Gain Much From Trump Drug Price Deals, an Axios article posted November 13, 2025 by Maya Goldman.

Costs for Patients With Employer-Sponsored Health Coverage

There are conflicting views of whether employer group health plans currently pay higher prices than the online DTC prices and whether patients with employer-sponsored coverage would save money by using the DTC program. As reported by Axios, “discounted prices that will be offered on the government’s TrumpRx portal may not benefit the more than 305 million Americans with insurance, who’ll likely have access to cheaper medicines through their plans. The marked-down cash prices on TrumpRx could offer the convenience of comparison shopping—but the 92% of Americans who already have health coverage likely have lower out-of-pocket costs through their plans, said Edwin Park, research professor at the McCourt School of Public Policy at Georgetown University.”

Some analysis compared the employee copay to the DTC price; however, this focus on patient/employee cost-sharing overlooks what the plan sponsor/employer pays for prescriptions. Marsh McLennan Agency explained it’s unclear how TrumpRx would integrate with existing insurance plans: “It is important to note that at least initially this solution does not contemplate what members covered under Commercial plans currently pay via copays or coinsurance that could result in a lower out of pocket cost for the member. Additionally, it does not provide member level tracking or credit for any cash pay prescription drugs towards the member individual deductibles or out of pocket maximum.” Since patient cost-sharing isn’t integrated, “While this may change over time, it is not currently a tool that employers can use within their existing health insurance plans to reduce costs,” according to Marsh.

Employer Options Under TrumpRx

At a high level, employers’ main options are likely to:

• Cover GLP-1s under a negotiated price match through their PBMs or drug manufacturers, or drug companies may voluntarily cut their prices to TrumpRx levels
• Not cover GLP-1s and integrate DTC with the health plan to help employees access desired medications, according to Mercer.

Option 1: Price Matching

Publicly available direct prices through TrumpRx are expected to pressure all stakeholders to lower prices (e.g., drug companies, PBMs and employers).

For GLP-1s, in particular, “We would expect commercial payers to demand to use these posted prices as ceiling prices,” Rena Conti, a health economist and associate professor at Boston University, told The Washington Post, referencing the TrumpRx prices. Drug companies, health payers and pharmacy benefit managers (PBMs) might negotiate with one another and “decide that they’re going to match that same direct-to-consumer price and forego, say, a rebate,” Louis Zollo, national pharmacy practice leader and VP at Segal, told HR Brew. It remains to be seen what the role PBMs would have in these negotiations or whether insurance companies and plan sponsors would directly contract with drug makers for GLP-1s.

Option 2: Integrating With DTC

TrumpRx and other DTC programs are not replacements for existing insurance coverage but alternative purchasing options. Employers will likely look to explore new benefit strategies to support DTC drug purchases, according to Marsh. Carve-outs would keep standard coverage for most prescriptions but steer members to TrumpRx or manufacturer programs for select high-cost drugs, according to Phia Group. Another strategy would be excluding the drug from a company’s health plan but setting up a health reimbursement arrangement that gives employees cash to purchase the drugs elsewhere, Julie Selesnick, founder and principal attorney with Health Plan Legal Counsel, told Bloomberg Law.

DTC Drawbacks for Employers

Buchanan attorneys Dae Y. Lee and Natalie C. Oehlers explain the drawbacks of DTC as follows: “For plan sponsors, TrumpRx creates a two-market problem. Members who bypass their insurance to purchase through TrumpRx will save money individually, but the plan itself loses visibility into drug utilization. This erodes data capture that employers need for care management, adherence monitoring, and formulary strategy. In effect, while members may save at the counter, the plan loses critical insights, and total drug spend may become more unpredictable. If employees increasingly bypass the plan by using TrumpRx, sponsors risk losing the data necessary to prove they are meeting their fiduciary obligations.”

What’s Next

The presence of DTC prices puts pressure on drug companies and PBMs to deliver more favorable pricing and value to employer group health plans. It is not clear how DTC programs will integrate with existing insurance plans or impact overall drug pricing. President Trump is negotiating more agreements to offer MFN pricing. TrumpRx is expected to be available in January 2026.

View the International Foundation’s Presidential Administration and Employee Benefits Toolkit for more information.

Developed by International Foundation Information Center staff. This does not constitute legal advice. Please consult your plan professionals for legal advice.