The federal government launches a pharmaceutical marketplace in January where Americans can buy drugs directly from manufacturers at prices the White House forced down through tariff threats. Two weight loss pills lead the platform at $149 per month for starter doses.
Novo Nordisk’s oral Wegovy received FDA approval December 22. Eli Lilly’s orforglipron awaits approval expected by spring. Both deliver comparable weight loss to weekly injections that cost over $1,000 monthly.
President Trump signed Executive Order 14276 on May 12, 2025. The order directed the Department of Health and Human Services to force pharmaceutical companies to match the lowest prices charged in developed countries. Manufacturers received 30 days to get price reduction targets, then six months to comply or face tariffs.
Fourteen of seventeen major pharmaceutical manufacturers signed agreements by December. Companies get three-year tariff exemptions in exchange for listing drugs on TrumpRx at most-favored-nation prices. They committed over $150 billion combined to United States manufacturing.
Gilead Sciences cut its hepatitis C drug Epclusa to $2,425. The original price was $24,920. Sanofi reduced blood thinner Plavix to $16 from $756. Novartis slashed multiple sclerosis drug Mayzent to $1,137 from $9,987. Boehringer Ingelheim dropped diabetes medication Jentadeuto to $55 from $525.
TrumpRx does not sell drugs but connects patients to manufacturers’ direct-to-consumer programs, eliminating pharmacy benefit managers and insurance markups. The platform launched through Executive Order 14270 on September 30, 2025. All fifty state Medicaid programs will pay most-favored-nation prices on products from the fourteen companies.
The $149 monthly price applies only to starter doses. Neither manufacturer has disclosed pricing for higher doses that patients need after beginning treatment. The starter price puts initial access within reach but leaves total treatment costs unclear.
Medicare will cover the drugs at $245 monthly for obesity with related health conditions. That represents less than half what the Biden administration proposed before Trump withdrew that rule. Medicare beneficiaries pay $50 copays. The pricing enables Medicare coverage for weight loss treatment for the first time.
The approach mirrors Trump’s 2020 attempt at most-favored-nation pricing through a proposed Medicare rule. Courts blocked that regulation before implementation. This version uses executive authority over trade and tariffs instead of Medicare rulemaking.
Three pharmaceutical manufacturers have not signed: AbbVie, Johnson & Johnson, and Regeneron. More than 100 million American adults have obesity. One in eight Americans uses an injectable GLP-1 medication. The pills require no refrigeration, needles, or weekly injection routine.
In clinical trials, Novo’s pill produced 13.6% average weight loss. Lilly’s pill delivered 12.4% weight loss. Both showed gastrointestinal side effects similar to injectable versions. The pharmaceutical industry trade group PhRMA estimated most-favored-nation pricing could cost manufacturers $1 trillion over ten years in Medicaid alone.
The federal government now operates a pharmaceutical marketplace where prices drop through tariff threats rather than legislation, removing intermediaries while fourteen global manufacturers comply and three resist.
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