Drug Price Drop: Trump Claims Credit, Experts Cite Generics, IRA

A record drop, and a fight over who caused it

Prescription drug prices in the United States fell 3.1% in the year ending in July. That is the steepest year-over-year decline since 1963, and it came while overall medical costs kept rising.31 July alone saw a 0.8% monthly drop.32 Over the six months through July, prices fell at a seasonally adjusted annual rate of 6.6%, the sharpest six-month slide on record.33 A conservative business column reported in mid-October that September's figures went further and set a new record for annual decline.37

President Trump has made the decline a centerpiece of his midterm message. He says his "most favored nation" (MFN) agreements with drugmakers and the TrumpRx.gov website have taken the U.S. "from the highest prescription drug prices, by far, anywhere in the world, to the lowest."22 He has said the issue alone "should win us the midterms."22 White House spokesman Kush Desai said no modern president except Trump had managed to cut drug prices sharply across the board.33 CMS Administrator Mehmet Oz called the savings "seismic" and credited the president directly.34

The coverage reaches a fairly consistent conclusion. Prices really did fall, but the administration's account of why doesn't hold up. Outlets ranging from the Associated Press to FactCheck.org quoted experts who think other forces did most of the work.2534 My reading, after going through the reporting: Trump's deals have produced a handful of real discounts, mostly for weight-loss drugs, but there is little evidence they explain a market-wide index move. Some of the factors that likely do explain it began before he took office.

What the index actually measures

The Bureau of Labor Statistics' prescription drug index doesn't track the list prices drugmakers set. It tracks what pharmacies receive when they fill a prescription: the patient's payment at the counter plus whatever private insurance or Medicare Part D pays.33 So a drop in the index can mean insurers negotiated better deals or patients switched to cheaper drugs, not just that manufacturers cut prices.33 Critics have also noted that the index covers only part of the drug market and misses the web of rebates passed among manufacturers, middlemen and consumers.23

How BLS handles generics matters a lot here. About six months after a brand-name drug loses patent protection, the agency swaps the brand in its sample for the cheaper generic and counts the difference as a price drop.33 Several blockbuster drugs lost exclusivity over the past year. Vanderbilt's Stacie Dusetzina said that could be pulling the index down, especially if those drugs were widely used.33 Johns Hopkins researcher Jeromy Ballreich, quoted by FactCheck.org, also named new generics and biosimilars as a likely driver.34

Weight-loss drugs: the strongest case for the White House, with caveats

The administration's best evidence is GLP-1 drugs. In November 2025, Trump announced deals with Eli Lilly and Novo Nordisk to sell drugs like Wegovy and Zepbound through TrumpRx for roughly $245 to $350 a month.1 Under a Medicare pilot that started in July, the two companies charge the government $245 a month for Wegovy, Zepbound and Foundayo, and eligible patients pay a $50 copay.39 Before that, monthly prices charged to insurers had been above $1,000.33 KFF's Cynthia Cox said the Medicare pilot may have contributed to July's 0.8% monthly drop.34

But experts in several outlets argue the GLP-1 market was already heading this way. Patchy insurance coverage for weight loss created huge demand for cheaper cash prices, and compounded versions gave the brand-name makers real competition.33 Cox listed competition within the drug class, pressure from compounding pharmacies, price-sensitive patients paying out of pocket, and pressure from insurers and employers.34 Brookings' Richard Frank pointed out that GLP-1 sales are so large that their price moves carry heavy weight in the index.34

TrumpRx's own listings support that view. When the site launched in February, the oral Wegovy pill cost $149 a month, the same price Novo was already charging through its own direct-to-consumer channel. Customers ordering Zepbound vials on TrumpRx were sent to Lilly's LillyDirect site.4 The posted prices also have conditions. In September, the $199 Wegovy and Ozempic pen prices applied only to the first two fills at the lowest doses and rose to $349 a month after that.10 International comparisons look worse. KFF found Ozempic costs $349 on TrumpRx, while the next-highest price in several other wealthy countries is $190.22

All of this points to the White House getting credit for drug prices that competition was already pushing down. The deals made those lower prices easier to see and extended them to Medicare. They didn't start the decline.

Cancer drugs and the 'lowest price in the world' claim

Cancer drugs give the administration its best examples, but there aren't many of them. Rydapt, a blood cancer treatment from Novartis, costs $2,909 for 56 capsules on TrumpRx. That's less than half the $5,901 price in France, the next-cheapest country.22 Novartis offered Rydapt and other drugs through TrumpRx under its December deal.17 KFF found TrumpRx prices competitive abroad for a small number of cancer and cholesterol drugs.19

Across the wider sample, the record is uneven. KFF looked at 32 brand-name drugs on TrumpRx that have no generic or biosimilar alternative. TrumpRx was cheaper than the international average for 17 and more expensive for 15. Only five were the lowest-priced anywhere, and 13 were the most expensive.22 The rheumatoid arthritis drug Enbrel costs $3,354 a month on TrumpRx, more than five times the $641 average abroad.22 KFF's Juliette Cubanski called the results "a mixed bag."22

The two sides disagree on how to read this. Antonio Ciaccia of 46brooklyn Research counts about 80 brand-name drugs on the site, many more than KFF could compare. He also notes that published foreign prices can leave out confidential discounts.22 Those are reasonable caveats. Still, they don't rescue the specific claim that Americans now pay the lowest prices in the world. Even a supportive fact check concluded the evidence doesn't back that blanket statement.30

Secret deals, limited reach

The MFN program now includes 26 drugmakers. The administration says they cover 89% of the branded-drug market, after nine mid-sized companies, among them Teva, Astellas and BeOne, signed on in August.12 The newer deals cover drugs for hemophilia, Parkinson's disease and several cancers.11 Companies receive tariff relief in exchange.15

Those deals don't reach most Americans. For drugs already on the market, MFN prices apply only to state Medicaid programs, cash purchases through TrumpRx and certain GLP-1 sales to Medicare or Medicaid. They don't change prices for people with private insurance.34 Medicaid patients already pay just a few dollars per prescription, so the savings go mostly to state and federal budgets, not to patients.15 The contract terms remain secret. That's why analysts call the claimed savings unverifiable even now that all 50 states have joined the Medicaid "GENEROUS" model.21 Corporate filings and records requests have shown that some deals last only three years.16 Public Citizen also found that the deals exempt drugmakers from other pricing initiatives.23

That exemption is the most important detail in the policy, in my view. CMS finalized GLOBE, a mandatory Medicare Part B model that ties payments for drugs including cancer therapies to international prices. Companies that join GENEROUS can get waivers from it. Of 36 drugs that would otherwise fall under GLOBE, only about four, from three companies, actually do.13 CMS cut its savings projection from $11.9 billion to $440 million over seven years.13 Even so, the drug industry's main trade group, PhRMA, sued to block the rule.20 Harvard-affiliated researcher Thomas Hwang warned that a voluntary Medicaid deal that shields companies from costlier Medicare requirements "could be a bad deal for the government and taxpayers."15 Other experts expect drugmakers to raise prices abroad or delay launches in countries with low prices, which would push up the benchmarks the U.S. price is pegged to.15

The policy Trump kept running

Many experts assign more weight to the Inflation Reduction Act than to anything new. Under the Biden-era law, Medicare negotiated prices on 10 widely used drugs, and those prices took effect in January.33 Dusetzina said those drugs are common enough to show up in the index. She also said MFN pricing can't explain the decline because the models built to apply it hadn't launched yet.36 Frank said the IRA is where he'd "place my money."33 He is less sure about it elsewhere, though, calling a large IRA effect possible but unlikely and urging caution about any single explanation.34 Desai dismissed the IRA argument as "absolutely idiotic." He noted the negotiated prices took effect in January without changing the February index.34

The most defensible conclusion is the one the AP itself reached: GLP-1 competition, generics and Medicare negotiation probably mattered more than the president's dealmaking.25 Ballreich made the point most sharply: perhaps Trump's biggest contribution to lower drug prices was that he didn't dismantle Medicare price negotiation.34