(The Center Square) – AstraZeneca has now joined Pfizer in agreeing to sell its drugs to state Medicaid programs at “most-favored-nation” pricing and deeply discounted rates on TrumpRx.gov
But what does that mean?
Last week, President Donald Trump and Health and Human Services officials announced the forthcoming creation of TrumpRx, a direct-to-consumer website where Americans will be able to buy some of their medications for less. They also unveiled the first-of-its-kind deal they’d reached with pharmaceutical giant Pfizer on drug pricing for Medicaid – a deal they’ve now secured with AstraZeneca, as well.
The drug manufacturers have also mentioned selling all of their new drugs at most-favored-nation pricing, though the implications of this are still unclear.
How it started
In May, Trump signed the executive order “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” aimed at addressing inequities in what the U.S. pays for medical drugs compared to other wealthy countries.
Sometimes Americans pay 10 times more than citizens of an economic peer country for the same medication. Most of the time, it’s more like two or three times as much. Trump has framed it as other countries capitalizing on innovation underwritten by Americans, as the U.S. funds a large portion of pharmaceutical research and development.
“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,” the order reads.
What is “most-favored-nation pricing”?
Most-favored-nation pricing means the U.S. would pay no more for a drug than the lowest price paid by peer nations.
Where Big Pharma comes in
Trump threatened pharmaceutical companies that didn’t make the shift with “aggressive action” from his administration. Pfizer is the first to have reached an agreement with the administration and complied with the MFN directive, and now, AstraZeneca.
Who benefits?
Pfizer and AstraZeneca have agreed to sell their drugs to state Medicaid programs at most-favored-nation pricing. It’s not yet clear how the new pricing compares to what Medicaid has been paying, but it could result in real savings for states.
AstraZeneca CEO Pascal Soriot said Friday he believes the American economy will also benefit from the “equalization” of drug costs across countries.
“It’s a big win for patients and the healthcare system as a whole, but it’s also a big win for the economy and for taxpayers, because it supports rebalancing the cost of innovation across wealthy nations. For too long, America has shouldered a disproportionate portion of the world’s R&D,” Soriot said. “That imbalance is not sustainable.”
These companies have also committed to selling all new drugs at most-favored-nation pricing, though it’s unclear if this would again only apply to Medicaid programs and when it is supposed to go into effect.
“We also have MFN for all new prescription drugs, Mr. President. By the time this term is done, 95% of all drugs sold in America, branded drugs and generic will be available at most favored nation drug pricing,” Soriot said.
TrumpRx: Discounted prescription drugs sans middleman…
Some pharmaceutical manufacturers have recently begun offering some of their products on their websites for much less. TrumpRx is jumping on this direct-to-consumer bandwagon and will function as a kind of online marketplace for people looking to buy deeply discounted drugs.
So what’s the catch?
But people using TrumpRx can’t use insurance. There is no middleman with direct-to-consumer products – no CVS Pharmacy and no insurer, either. So TrumpRx is really for people without insurance or who have lost it temporarily or for instances where it makes more sense to pay a discounted price than to use insurance, like when insurance doesn’t cover a particular drug.
Pfizer has shared some of the drugs it has agreed to offer through the TrumpRx platform, some of which will be available at an 80% to 85% discount. Others will be discounted less, like Xeljanz. Xeljanz is an oral medication for ulcerative colitis and some types of arthritis, and patients can purchase it at 60% of its sticker price – which unfortunately is still over $3,600 per month.
In most cases, a medication will likely be cheaper (or much, much cheaper) with insurance. In Xeljanz’s case, it’s often covered through insurance and in some cases, patients pay only $25 a month, as the New York Times reported.
However, Trump said Friday drug prices would be going down “100%, 400%, 600% – 1,000% in some cases” and that these deals would “have a huge impact” on Medicare and Medicaid, but also on Social Security.
He gave an example of an expected 654% price reduction.
“One particular drug that’s hot, very hot – 654% on inhalers, COPD and asthma, as well as certain diabetics medications – they’re going to be averaging about 654% reduction in price,” he said.
Other downsides
Most of the cost of a drug comes from research and development, and the president has said the U.S. pays a “disproportionate amount” of those costs. Director of Medicare Chris Klomp has said the U.S. “[drives] more than 50% of global R and D, 50% of revenues, nearly 70% of profits” for pharmaceutical companies.
Some have said America’s new pricing arrangement will harm pharmaceutical R & D.
“The Trump administration is right to focus on foreign countries free riding off American innovation, but the administration needs to do more to address unfair practices abroad,” said the Pharmaceutical Research and Manufacturers of America, or PHRMA, in a statement shared with The Center Square.
“Other countries routinely undervalue medicines and limit their citizens’ access to the newest treatments. Most Favored Nation policies that would import these same prices into the U.S. would result in less access to treatments and cures and reduced investment in manufacturing and R&D.”
Does all of this actually make a difference?
The vast majority of Americans (92%, in fact, according to Census Bureau data) have health insurance and likely won’t need to use TrumpRx in most situations, from what is currently known about the platform.
And despite Pfizer’s agreement to sell its drugs to Medicaid programs at most-favored-nation pricing, Medicaid enrollees likely won’t notice much of a difference either, since they already get their prescriptions at little to no cost.
And it’s unclear at this time what the intended scope is for Pfizer and AstraZeneca’s new drugs to be offered at MFN pricing.
But if seen as a part of a broader movement in government for greater transparency in health care, the news isn’t insignificant.
A larger push for transparency
There’s been a concerted government effort in recent years to push for more transparency in an incredibly complex industry with inscrutable pricing. In his first term, Trump issued some executive orders that required hospitals and insurance companies to publicly disclose some pricing information. The Biden administration doubled down on this initiative by ramping up enforcement measures and noncompliance penalties and creating new requirements for prescription drug reporting and price comparison tools.
Chris O’Dell, a spokesperson for health care price transparency platform Turquoise Health, said the deal for MFN pricing and the development of TrumpRx will continue to advance price transparency in health care.
“I think what they’re doing is making a big splash and casting eyes and a conceptual need for transparency onto one of the most opaque and unaffordable corners of health care. And in that sense, it’s a good thing, even though it’s going to take months, if not years, for it to unfold,” O’Dell told The Center Square.
“The worst case scenario is it’s a big, splashy headline that does nothing… and the best case scenario is that there’s real change that means that you actually pay less for the drugs that you need,” O’Dell told The Center Square. “That has not happened.”
TrumpRx may not help most Americans in the near-term, but O’Dell doesn’t think it was a wasted effort.
“The administration is hell bent on letting people know what they’re going to pay for health care before they go in and get it. And they’re turning that focus on to drugs. And that’s a good thing,” O’Dell said.
“They’re… casting eyes and a conceptual need for transparency onto one of the most opaque and unaffordable corners of health care… It’s a good thing, even though it’s going to take months, if not years, for it to unfold.”
And unlike many government reforms that have unintended consequences and can make the problem they’re trying to solve even worse, O’Dell doesn’t foresee that with these changes.
“There’s nothing in this that would ever make someone pay more or be worse off than before.”
Other necessary reforms
But O’Dell and others say American health care still desperately needs reforms in another area of the pharmaceutical industry: pharmacy benefit managers.
The Commonwealth Fund describes PBMs as “companies that work with health insurers, large employers, and other payers to manage their prescription drug benefits.” AI search assist says they “help to reduce prescription drug costs through price negotiations and utilization management.” But many in the health care industry say they actually inflate drug prices and simply “add another layer of secrecy” to the drug pricing process.
“We need to make the PBMs also put their rates out… Hospitals did it, payers did it, but the PBMs got away with not doing it. Why is that? And I would love to see the administration tackle that and say now you have to publish historical net price,” O’Dell said.
Miriam Paramore, founder of RxUtility, a website that helps insured Americans find and access prescription savings, also mentioned PBMs in an interview with The Center Square. Paramore thinks the administration’s announcement does address a driver of health care costs with MFN pricing. But a good next step would be PBM reform.
“What is as significant of a driver with the overall price of medications is also what you see in PBM reform. MFN pricing and PBM reform are big drivers of the cost of drugs,” Paramore said.
And so does PHRMA. It called PBMs and other federal programs the “real drivers of higher prices in the U.S.”
“PBMs get big discounts on medicines while charging patients full price. Hospitals abuse the 340B program to mark up drug prices by 700% or more. Addressing these abusive practices would dramatically lower drug prices for U.S. patients,” PHRMA said in a statement.
What’s next
TrumpRx is expected to launch in January 2026. The administration has said more deals with other drug manufacturers are underway.
Both Pfizer and AstraZeneca have pledged to invest tens of billions ($120 billion all told) in their manufacturing presence in the U.S. AstraZeneca just broke ground on a new, $4.5 billion plant that will make active pharmaceutical ingredients, most of which the U.S. currently gets from other countries like China and India.
These investments will shield those companies from tariffs for the next three years, as Trump has said companies that pledge significant American investment will be.
Two Storms, One Harvest
Every food crisis in living memory has been a one-shock event. The 2008 price spike was a commodity bubble. The 2020 shortages were a logistics failure. The 2022 grain scare was a war on one exporter’s ports. Each time, the system bent, adjusted, and recovered, and each time the experts assured us afterward that global markets are simply too big and too diversified to fail.
What nobody in Washington seems eager to discuss is that 2026 is shaping up to be something the modern food system has never actually faced. Two independent shocks, one climatic and one geopolitical, are converging on the same harvest cycle at the same time. Not sequentially. Simultaneously.
Start with the weather. The Pacific Ocean is currently building toward what forecasters now openly call a record event. NOAA’s Climate Prediction Center puts the odds of at least a strong El Niño near 88 percent, with roughly two in three odds it reaches “very strong” status, the tier reserved for perhaps three or four events in the entire satellite era. Every major global model now projects a median peak in Super El Niño territory, and most of them project it exceeding the 2015-16 event, which until now held the modern record. Sea surface anomalies were already brushing the super threshold in mid-July, months before these events normally peak. The atmosphere has already shifted into El Niño mode, and the event is forecast to crest in late fall and early winter.
This is not about “climate change.” It’s about the standard cycles of weather, and the cycle we’re currently in is one that has likely devastated societies in the past. We’re better prepared as a society today, but not all Americans are equally prepared.
Serious households have started doing the quiet math on their own. Grocery bills tell part of the story, and the forecast maps tell the rest, which is why long-term food storage has moved from fringe hobby to mainstream line item in the family budget, with established suppliers like Heaven’s Harvest seeing demand from people who five years ago would have rolled their eyes at the idea. That instinct is not paranoia. It is pattern recognition, and the pattern is worth walking through carefully.
Editor’s Note: Heaven’s Harvest IS a sponsor, but the warnings of this article are real and would be written even if we didn’t have a survival food sponsor. With that said, those who take advantage of what they offer can use promo code “Patriot” for 15% off.
The Fertilizer Clock Is Already Running
While the Pacific warms, the second shock has been unfolding in the Strait of Hormuz. The conflict with Iran turned the world’s most important energy chokepoint into a contested waterway, and the consequences reach far beyond the gas pump. Roughly a third of global fertilizer trade moves through Hormuz, and the disruption sent urea prices up 86 percent year over year by March, with a 53 percent jump in a single month.
The World Bank projects energy prices rising about 24 percent in 2026 and fertilizer about 31 percent. By its own accounting, fertilizer prices ran 35 percent higher in the first five months of this year than the same period last year.
Here is the mechanism the nightly news will not explain. Fertilizer is not a grocery item. It is a time-delayed input. The nitrogen a farmer in Iowa or Punjab could not afford to apply this spring does not show up as a problem this spring. It shows up as a thinner harvest six to twelve months later.
The World Bank’s own food security brief concedes that the effects of reduced applications earlier this season “are likely to become visible only later in harvest outcomes.” Translate that from institutional language into plain English and it means this. The damage is already done, it is already in the ground, and we are simply waiting for it to arrive on the shelf.
Now check the calendar. Six to twelve months from the spring planting season lands us squarely in late 2026 and early 2027. Which is precisely when the strongest El Niño in the instrumental record is forecast to peak, bringing its signature droughts to Southeast Asia, Australia, southern Africa, northern Brazil, and South Asia, the very regions that grow the world’s rice, sugar, and oilseeds.
The World Bank warns openly that a strong El Niño “could disrupt multiple crop belts simultaneously” on top of the conflict-driven input costs. Their baseline projection assumes the Middle East disruptions ease by autumn. What in the last two years of Middle East history suggests that assumption is safe?
The System Has No Slack Left
The comfortable answer is that global markets always adjust. But adjustment requires slack, and the slack is gone. Global cereal production is expected to decline from last year’s records even before El Niño does its work. The UN World Food Programme, hardly a den of right-wing preppers, is calling this the most significant disruption to its supply chains since Covid and the invasion of Ukraine, and its supply chain director put the stakes bluntly.
Today’s supply chain challenges are tomorrow’s hunger crisis.
There is also a political dimension that markets cannot price. When food gets scarce, governments do not behave like economists. They behave like politicians. Export bans, hoarding mandates, and panic buying at the national level turned the modest rice shortfall of 2008 into a global crisis, and analysts are already warning that import-dependent nations are the first dominoes.
The 2015-16 Super El Niño, a far weaker event than what is now forecast, threw tens of millions into food stress across Africa and Asia. This one is projected to be stronger, and it arrives with fertilizer already rationed by price and shipping lanes already contested by missiles.
What Joseph Knew
Scripture does not treat preparation for lean years as faithlessness. It treats it as wisdom delivered in advance to those willing to act on it.
Behold, there come seven years of great plenty throughout all the land of Egypt: And there shall arise after them seven years of famine; and all the plenty shall be forgotten in the land of Egypt.
Joseph did not respond to that warning with a hashtag or a committee. He stored grain during the years of abundance, and when the famine came, Egypt stood while its neighbors begged. The lesson is not that famine is certain. It is that the time to prepare is precisely when preparation still looks optional.
Nobody who filled a pantry in a year of plenty has ever regretted it, and nobody standing in an empty aisle has ever been glad he waited for certainty.
None of this calls for panic, and panic is the enemy of sound judgment anyway. It calls for the same unglamorous prudence our grandparents considered ordinary. Keep some cash margin, know your local growers, and put real food in deep storage while it is cheap and available, because the entire arc of this story is that cheap and available is a closing window.
Families looking for a straightforward place to start can visit Heaven’s Harvest and use promo code Patriot for 15 percent off long-term storable food. The forecasts may yet soften, the strait may yet reopen, and we should pray they do. But hope is a fine thing to hold and a foolish thing to eat.