The affordability of prescription drugs has been discussed for years. From federal programs (such as Medicare and Medicaid), state insurance programs, employer group plans and down to the individual, the costs for many drugs—including insulin and now GLP-1s—have been rising to levels that compromise the ability to pay for them. In the past year, several new ideas for reducing prescription drug costs have been shared by the Trump administration.
On February 18, 2026, the International Foundation conducted a webcast, “Rx Changes: New Laws and Future Impacts to Prescription Drugs,”, which detailed several new prescription drug issues:
- A court case settlement by the Federal Trade Commission (FTC) and pharmacy benefit manager (PBM) Express Scripts, Inc. (ESI) addressing pricing practices
- The new PBM fee disclosure and compensation regulations
- The newly introduced TrumpRx.gov website, launched on February 5, 2026.
This blog will focus on TrumpRx and the impact to plan sponsors. Please review our previous blogs on prescription drugs, including PBM Fee Disclosure Regulatory and Legislative Update and the Executive Order on Drug Discounts Has Uncertain Impact on Employers’ Price Negotiations.
What is TrumpRx?
TrumpRx originated from a May 12, 2025 Executive Order (EO) on establishing most-favored nation pricing, meaning that U.S. pricing will be in line with the lowest paid by other developed nations. The EO was followed up by a Department of Health & Human Services (HHS) fact sheet for manufacturers “to commit to aligning US pricing for all brand products across all markets that do not currently have generic or biosimilar competition with the lowest price of a set of economic peer countries.”
TrumpRx was launched as a government-operated website on February 5, 2026 as a “hub,” steering individuals to drug manufacturers’ coupon programs or the manufacturers’ own direct-to-consumer (DTC) websites where individuals can purchase their medication, usually by paying cash outside of a prescription drug plan. TrumpRx doesn’t sell prescription drugs but acts as a central location for individuals before purchasing. As of March 3, 2026, there are 44 different prescriptions available for conditions including asthma, arthritis, diabetes, etc.
What are some TrumpRx unknowns?
According to speaker John Barlament, shareholder, Reinhart Boerner Van Deuren, S.C., “there are many unknowns about TrumpRx.gov and the impact on the benefits industry.” First, TrumpRx didn’t originate from a law; rather, the “foundation” seems to be President Trump’s tariff threats against prescription drug companies, Barlament said. The Supreme Court ruled on February 20, 2026 that President Trump wasn’t authorized to impose certain tariffs. Now there is some uncertainty regarding drug manufacturer agreements with the presidential administration to provide most-favored nation pricing via TrumpRx. However, according to Managed Healthcare Executive, some pharmaceutical industry observers said that the Supreme Court ruling “is not likely to upset the existing deals that the drugmakers have made with the administration, partly because the administration still has leverage with the threat of tariffs under other laws.” Second, due to no underlying laws in place for TrumpRx, Congress could elect to stop any future funding for the website.
What is the impact on plan sponsors and employers?
Barlament mentioned that he doesn’t think there will be a role for plan sponsors, at least initially, to be involved with leading employees to the TrumpRx website. For those plans with high-deductible health plans (HDHPs), he suggested that the availability of purchasing prescription drugs through the TrumpRx process shouldn’t make individuals ineligible to contribute to their health savings accounts (HSAs).
Additional considerations for plan sponsors include:
- The potential to lose important PBM prescription drug data by encouraging plan enrollees to use the TrumpRx process to obtain prescription drugs
- Concern for potential drug interactions that PBMs can typically recognize and address at the pharmacy before the individual receives their prescriptions
- For individual purchasing prescriptions through a DTC process, whether plans will provide credits or reimbursements toward their deductible or maximum out-of-pocket limits, and whether this could affect contract terms with their PBMs
Barlament noted that the FTC/ESI court case presented at the beginning of this webcast by Susan Hayes, chief executive officer of Pharmacy Investigators and Consultants does address the issue of DTC pricing and accumulations toward deductibles and maximum out-of-pocket limits.
Next Steps for Plan Sponsors
There are still questions and outstanding issues about TrumpRx. While the immediate impact for plan sponsors appears to be low, these developments encourage plan sponsors to prepare and communicate with their PBM and third-party administrator partners. Self-funded plans will generally have more flexibility to evaluate the need for future plan design changes.
Stay tuned to the International Foundation for more information on these important prescription drug issues. For the latest updates, visit the Presidential Administration and Employee Benefits toolkit.
Developed by International Foundation Information Center staff. This does not constitute legal advice. Please consult your plan professionals for legal advice.
