In his push to “lower prescription drug prices for all Americans,” President Donald Trump is calling on three specific actions in his Great American Healthcare Plan, released January 15.
The plan calls on codifying into law “most favored nation (MFN) drug pricing,” states a White House Fact Sheet, in addition to ending “kickbacks from pharmacy benefit managers (PBMs) to the large brokerage middlemen,” and making more prescription drugs available for over- the-counter purchase.
Subsidizing Drugs in Other Countries
Trump explained the purpose of MFN drug pricing in his May 2025 executive order (EO).
“The United States has less than five percent of the world’s population and yet funds around three-quarters of global pharmaceutical profits,” Trump wrote in the EO. “This egregious imbalance is orchestrated through a purposeful scheme in which drug manufacturers deeply discount their products to access foreign markets, and subsidize that decrease through enormously high prices in the United States.”
The EO continued. “Americans should not be forced to subsidize low-cost prescription drugs and biologics in other developed countries, and face overcharges for the same products in the United States. Americans must therefore have access to the most-favored-nation price for these products.”
Trump, through the EO, went on to call upon the Secretary of Health and Human Services, Robert F. Kennedy Jr., and others in his administration, to “communicate most-favored-nation price targets to pharmaceutical manufacturers to bring prices for American patients in line with comparably developed nations” and “facilitate direct-to-consumer purchasing programs for pharmaceutical manufacturers that sell their products to American patients at the most-favored-nation price.”
Drug Companies Deals
Following the EO, the White House announced agreements with Eli Lilly and Company and Novo Nordisk that allow Americans to obtain certain drugs used to treat obesity, diabetes, and migraine, among other conditions, through government programs at a reduced price.
Similar deals were reached with Pfizer and AstraZeneca regarding fertility drugs, as reported by Health Care News.
However, in the absence of legislation, some analysts, such as health care economist Devon Herrick, have previously told Health Care News, there is a “possibility that Trump’s drug deals won’t long survive his presidency.”
Regarding the drug deal with Pfizer in a matter of 10 days, Albert Bourla, CEO, told Fortune Magazine, “It was very clear to me that what was in his mind in the first administration had now become a very intensive itch that needed to be scratched: He was very adamant that he can’t tolerate that other rich nations pay less than Americans are paying.”
MFN Pricing Controversy
MFN pricing, however, has proven somewhat controversial in the past, with critics such as Sally Pipes, president and chief executive officer of the Pacific Research Institute, describing it as “soft on math, hostile to innovation, and blind to the realities of drug development.”
“This policy would tie Medicaid reimbursements to the lowest prices paid in other developed countries—countries where government officials dictate drug prices under threat of coercion, patent confiscation, or market exclusion,” wrote Pipes in a June Health Care News commentary.
Yet others, such as Health Care News managing editor AnneMarie Schieber, note that MFN pricing could compel drug companies to strike better deals abroad, leading to fairer prices in the United States.
“Free-market thinkers consider MFN price control,” said Schieber. “But, Congress or any administration has no power to set drug price rules in other countries, especially those with socialized health care systems,” said Schieber.
“MFN will incentivize those drug companies to make a hard bargain with those countries, knowing with MFN pricing, they can’t go back to the American market to make up the price difference,” said Schieber. “This could lead to fairer drug pricing without technically being ‘price control.’ Drug companies will still be free to set their own prices. Maybe this time, they won’t sell their products so cheaply, elsewhere.”
Power of OTC Drugs
Two analysts, Devon Herrick, a health care economist, and Jeffrey Singer, M.D., a senior policy fellow at the Cato Institute, praise The Great Healthcare Plan’s call for greater over-the-counter access.
“This goal to allow more OTC medications is far more powerful than people realize,” said Herrick. “At least initially, the vast majority of care Americans receive is self-care using OTC drugs. OTC drugs are about 95 percent cheaper than they were before losing patent protection and becoming available over the counter. Self-medication with an OTC saves money, saves a doctor’s visit, and saves inconvenience. Switching prescription drugs to OTC boosts access to care.”
The administration should intensify efforts to make more prescription drugs OTC, says Herrick. “Not only should the FDA approve more applications to switch prescription drugs to OTC, but the agency should also identify good candidates and solicit companies willing to apply,” said Herrick. “Any OTC drug maker should be able to apply to sell an off-patent drug OTC, not just the original manufacturer.”
Question of Drug Misuse
Similarly, Singer lauded Trump’s efforts to reclassify more prescription-only medications as OTC.
“[M]oving a medication from prescription-only to over-the-counter almost always puts downward pressure on its price,” Singer wrote in a blog post for the Cato Institute.
Birth control pills, GLP-1s used to treat obesity, and pre- and post-exposure prophylactics for HIV were specified by Singer as drugs Americans should be able to access over the counter.
“Policymakers might argue that adults could misuse these drugs if they can buy them over the counter,” wrote Singer. “However, we already trust people with many over-the-counter medications that can be deadly if misused.”
Singer cites some well-known examples of OTC that could be harmful if misused.
“Acetaminophen can cause fatal liver failure in overdose,” wrote Singer. “Aspirin can trigger life-threatening metabolic issues. Large doses of diphenhydramine (Benadryl) can lead to lethal heart rhythm problems, and even common NSAIDs (e.g., ibuprofen and naproxen) can cause kidney failure, seizures, and more.”
However, rather than require individuals to get prescriptions for these common OTC drugs, wrote Singer, “we rely on labels, warnings, and the fact that most people don’t want to poison themselves.”
Singer continues. “The potential for harm has never been a valid reason to treat adults as if they can’t make their own choices,” wrote Singer.
Daniel Nuccio, Ph.D. ([email protected]) is a spring 2026 College Fix journalism fellow, reporter, and editorial associate for Health Care News.
