Ever get to the pharmacy counter and feel a sense of dread before they tell you the price? During his presidency, Donald Trump promised to fix this. His approach targeted a system far more complex than a simple transaction between you and your pharmacist.
So why is it so complicated? A major reason involves powerful middlemen you’ve likely never heard of: Pharmacy Benefit Managers, or PBMs. Think of them as a giant coupon-clipper for your insurance company, negotiating big discounts from drug manufacturers behind the scenes.
This creates two different prices for the same medicine. A drug might have a $500 official “list price,” but after the PBM negotiates a secret $200 discount—called a rebate—your insurer only pays the $300 “net price.” The problem is, your own copay is often calculated based on that higher $500 sticker price, leaving you to wonder why the savings aren’t passed on.
Top 10 Most Commonly Used Medications
Understanding which medications people use most can highlight why drug pricing matters so much. Here’s a list of 10 widely used prescription drugs, along with their general use and how pricing complexities may affect them:
Eliquis – A blood thinner used to prevent strokes. Prices can be impacted by PBM rebates, leaving patients with high copays despite negotiated discounts.
HumaPen Savvio Graphite – A pen used for insulin delivery. This insulin device could benefit from Trump’s Senior Savings Model, which capped insulin costs at $35 for eligible seniors.
Ozempic – Used to help manage blood sugar in type 2 diabetes and support weight management. List vs. net prices negotiated by PBMs may affect your out-of-pocket cost.
Ventolin Inhaler (Albuterol) – Treats asthma. Like many commonly used drugs, PBM rebates may determine whether your copay is close to the true net price or the higher list price.
Xarelto – Another blood thinner, used to reduce the risk of blood clots. Pricing can vary widely depending on PBM negotiations.
Domperidone – Treats nausea and digestive issues. This is one example where imported drugs from Canada could, in theory, reduce costs if safety regulations allow.
Thyroid (Levothyroxine) – Treats hypothyroidism. This commonly used medication highlights how complex insurance pricing and rebates can affect everyday treatments.
Asacol (mesalamine)– Used for inflammatory bowel diseases like ulcerative colitis. Out-of-pocket costs can be unpredictable due to PBM rebate structures.
Seroquel (Quetiapine) – Prescribed for mood disorders like bipolar disorder. PBM rebates and insurance coverage play a big role in what patients actually pay.
Wellbutrin XL (Bupropion XL) – An antidepressant. Pricing may be impacted by list vs. net pricing and whether insurance plans pass savings to patients at the counter.
What Was Trump’s ‘Rebate Rule’ and Why Did It Target Middlemen?
A signature effort of the Trump administration’s drug pricing reform was the “Rebate Rule,” a plan directly aimed at Medicare Part D. The idea was to force the discounts that Pharmacy Benefit Managers (PBMs) negotiate to be passed directly to seniors at the pharmacy counter, immediately lowering their out-of-pocket costs for expensive drugs.
However, insurers and PBMs argued this would simply shift the cost. They explained that they use those rebate dollars to keep monthly premiums low for all their members. Without that money, they warned, premiums would have to rise for everyone, not just for those taking high-cost medicines.
Faced with this intense opposition and government projections of rising premiums, the administration ultimately withdrew the proposal. This major plan aimed at eliminating the drug rebate “safe harbor” never went into effect, leaving the complex system of back-end rebates in place.
How Did Trump Try to Make Other Countries’ Low Drug Prices America’s Reality?
The Trump administration also took aim at the fact that Americans often pay the world’s highest drug prices. The proposed solution was an executive order creating the “Most Favoured Nation” (MFN) rule. The idea was simple: for certain expensive drugs administered in a doctor’s office, Medicare would pay no more than the lowest price paid among a group of other developed countries.
Based on an earlier concept known as the International Pricing Index, this plan targeted high-cost drugs under Medicare Part B, such as infused cancer therapies. The goal was to force drugmakers to give Medicare the same deep discounts they offer other nations, creating immediate savings for the government and for patients who pay a percentage of the drug’s cost.
The policy, however, never started. Pharmaceutical companies immediately sued, arguing the executive order was unlawful and would stifle the development of new medicines. Federal courts agreed and blocked the rule from taking effect. This ambitious attempt to directly tie U.S. prices to those abroad was ultimately withdrawn.
Could Importing Drugs from Canada Have Lowered Your Costs?
Beyond just controlling U.S. prices, the Trump administration also looked north for solutions. It finalized a policy allowing states to develop plans for importing certain prescription drugs from Canada, where they are often sold for much less. The logic was straightforward: create competition by giving Americans access to cheaper, identical medicines, which would, in theory, pressure pharmaceutical companies to lower their prices here at home.
The plan, however, immediately ran into major roadblocks. Drug manufacturers and health regulators raised significant safety concerns, arguing it would be difficult to guarantee that imported drugs were not counterfeit or improperly stored. Tracking millions of pills to ensure they are safe and effective is a massive logistical challenge, and critics argued the plan could open the door to dangerous products.
Due to these safety concerns and ongoing legal battles, the program has had a minimal real-world impact so far. While this broad approach to competition struggled, a much more focused effort did deliver direct relief to some Americans who needed a specific, life-saving drug.
Did Trump Actually Cap the Price of Insulin for Some Americans?
Of all the proposals, the most direct relief came from a program targeting one of the most notoriously expensive drugs: insulin. For many seniors, the effects of insulin price caps under Trump were very real. The administration launched the “Senior Savings Model,” a new Medicare option that delivered immediate, predictable savings for eligible beneficiaries.
At its core, the program allowed Medicare Part D plans offered by insurance companies to cap the monthly co-pay for insulin at $35. For a senior whose plan participated, that meant no more surprise high costs at the pharmacy counter—their out-of-pocket expense for a month’s supply of covered insulin was fixed at a much more manageable level.
However, this wasn’t a universal price cut. The key was that both insurance companies and seniors had to opt-in. It only applied to those enrolled in a participating Medicare plan, not to younger people or those with private insurance. This targeted approach provided a significant win for some, but it wasn’t Trump’s solution for high prescription costs across the board.
So, Did Trump Lower Drug Prices? The Final Verdict
The answer to “Did Trump lower prescription drug prices?” isn’t a simple yes-or-no. The reality involves a system of powerful middlemen, legal hurdles, and the crucial difference between a presidential promise and a policy that actually reaches the pharmacy counter.
The administration’s core strategy was to use executive actions to force major, disruptive change. But this approach often collided with a wall of legal and industry opposition, stopping ambitious plans aimed at middlemen and international prices before they could have a widespread effect.
So, what’s the bottom line for the average person?
• The administration’s focus was on big, disruptive ideas rather than passing new laws through Congress.
• Major initiatives such as the Rebate Rule and the Most Favoured Nation Rule were halted by legal challenges or withdrawn.
• A few targeted policies, like the insulin cap for some seniors, did provide direct financial relief.
With this context, as you evaluate future proposals on drug pricing reform or compare different political approaches, the key question becomes: What’s the plan to get it past
For inquiries about prescription medications, contact our team at Jason’s CanadaDrugstore.com by calling 1-800-226 3784 (CAN-DRUG) for assistance from our patient representatives or a licensed Canadian pharmacist.
This article provides medical information to help understand a condition or treatment plan but is not a diagnosis or treatment recommendation. Contact your doctor if you have concerns or symptoms. In case of emergency, call 911.
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