TrumpRx: A New Prescription for America’s Drug Costs? What Employers and TPAs Should Watch

Brady Bizarro, Esq.

When President Donald Trump announced TrumpRx, his new prescription drug pricing initiative, it sounded part marketplace, part policy shake-up, and part political theater. But beneath the headlines, TrumpRx reflects a real shift in how Washington – and the pharmaceutical industry – talk about lowering drug costs. For employers with self-funded health plans and the TPAs who administer them, the plan raises big questions: What happens if drug prices are tied to international benchmarks? What if PBMs must open their books? And how could this change the way your health plan buys medication? Let’s unpack what TrumpRx actually is, how it’s different from past efforts, and why it matters for anyone managing a self-funded plan.

The Core Idea: Cut Out the Middleman

At its heart, TrumpRx tries to do what every benefits manager wishes they could – get rid of hidden markups. The administration wants to connect patients directly with drugmakers through a government-run website, TrumpRx.gov, expected to launch in 2026.

Think of it as a federally endorsed Cost Plus Drugs: you search for a medication, see a transparent price, and buy straight from the manufacturer. Early deals, such as one with Pfizer, promise discounts averaging 50% and up to 85% for certain products. Those prices are pegged to what other developed countries pay – the “Most-Favored-Nation” (MFN) rule – and, in theory, Americans would no longer pay the world’s highest drug prices. For uninsured patients or people in high-deductible plans, TrumpRx could be a game-changer. For most employees in self-funded plans, though, the story is more nuanced. Plan copays are often already lower than these cash prices, and purchases outside the plan wouldn’t count toward deductibles. Still, TrumpRx’s transparency could give employers something priceless: a clear reference point for what a fair price really looks like.

Most-Favored-Nation Pricing: Importing Global Discipline

TrumpRx’s MFN pricing principle is simple but radical – if France, Germany, or Canada pays less, so should we. To make that happen, the administration is striking voluntary agreements with drug companies while brandishing trade threats like import tariffs for those that don’t comply. Pfizer’s agreement sets the template: lower prices across Medicaid and direct sales, plus major U.S. investment pledges in exchange for tariff relief. Other manufacturers are following suit. Even the pharmaceutical lobby, PhRMA, is developing its own direct-sale site – proof that industry would rather adapt than fight this head-on. For self-funded plans, MFN pricing won’t automatically appear in your PBM contract. But it changes the conversation. When your plan pays $800 for a drug that’s available globally – or through TrumpRx – for $400, that’s leverage. Employers and TPAs can use these public benchmarks to challenge PBMs and negotiate net-cost parity with the global market.

PBMs in the Spotlight

No surprise – TrumpRx takes aim at the middle of the supply chain. The administration argues that pharmacy benefit managers have turned rebates and opaque fees into profit centers. A 2025 executive order directs the Department of Labor to require full disclosure of all PBM compensation to ERISA plan sponsors. That means PBMs will soon have to spell out every dollar they receive—from manufacturers, pharmacies, or brokers—and explain how much actually goes back to the plan. It’s a big step beyond the existing disclosure rules from the 2021 Consolidated Appropriations Act, which left gray areas around PBM revenue. For employers, that transparency isn’t just data – it’s fiduciary armor. Under ERISA, you’re required to ensure plan fees are “reasonable.” Once DOL’s rules take effect, “I didn’t know” won’t cut it. You’ll need to read those reports, benchmark costs, and document that your PBM’s compensation structure serves participants’ best interests.

What This Means for Self-Funded Plans

Formulary Rethink

If MFN pricing forces manufacturers to slash list prices, your plan’s formulary tiers may need a refresh. Some drugs that were cost-prohibitive could move to preferred status. Others might be cheaper through TrumpRx’s direct-sale channel than through your PBM network. Forward-looking employers may explore hybrid models: keeping standard coverage for most prescriptions but steering members to TrumpRx or manufacturer programs for select high-cost drugs. TPAs will need to help model savings and manage member communications so employees understand their options.

Slower Drug Cost Growth (Maybe)

Will TrumpRx actually lower your pharmacy trend? Possibly, though not overnight. If manufacturers anchor prices to international benchmarks, the relentless 8–10% annual rise in specialty spend could ease. But savings could also be offset if companies trim rebates or launch new drugs at higher starting prices. Either way, employers should use 2026 renewals to stress-test budgets under different trend scenarios. Watch categories like autoimmune, oncology, and diabetes drugs, where global pricing pressure is strongest.

New PBM Contract Dynamics

TrumpRx’s transparency rules will make opaque PBM contracts harder to defend. Employers should:

• Request complete compensation disclosures now, before DOL requires them.
• Move toward pass-through contracts – fixed administrative fees, 100% rebate return, no spread.
• Benchmark against TrumpRx or MFN prices to spot gaps between what your plan pays and what’s publicly available.

For TPAs, this creates an opportunity to deliver more value: conducting PBM audits, modeling pass-through options, and translating data into actionable recommendations.

Compliance and Fiduciary Risk

Expect DOL audits to expand once PBM disclosure rules are finalized. Plan fiduciaries will need to show they reviewed PBM reports and acted on findings. Documentation is critical – meeting notes, consultant reports, and pricing analyses all count. State laws may add another layer. Some states already require PBM licensure or ban spread pricing. Others are exploring drug importation programs that could complement TrumpRx’s goals. TPAs should track both federal and state developments to keep clients aligned.

Strategic Takeaways

Transparency is coming – embrace it

TrumpRx accelerates a trend that benefits employers: more sunlight on where every drug dollar goes. Use that information to renegotiate PBM terms and align incentives with plan savings.

Benchmark relentlessly
MFN and TrumpRx prices provide tangible yardsticks. If your PBM or carrier can’t match those net costs, push for explanations or alternative sourcing strategies.

Simplify and communicate
If members hear about TrumpRx, they’ll ask whether they should use it. Prepare clear, non-technical FAQs: when cash pricing helps, when insurance still makes sense, and how each affects deductibles.

Document fiduciary diligence
Transparency cuts both ways – it empowers you, but it also increases accountability. Keep written records showing how you evaluate PBMs, fees, and formulary decisions.

TrumpRx is more than a campaign slogan; it’s a stress test for the U.S. drug pricing system. Whether it delivers sweeping savings or just sparks new competition, it’s pushing employers, PBMs, and manufacturers toward greater accountability and clearer pricing.

For self-funded employers and TPAs, the message is simple: data is power. Use TrumpRx’s transparency wave to your advantage – question the numbers, renegotiate where you can, and keep your plan nimble. Even if policy shifts again in the next election cycle, the expectation of honesty in drug pricing is here to stay.