WASHINGTON — The Trump administration is turning to an unconventional approach to lowering drug prices in the United States: striking deals directly with big pharma companies in an attempt to bring U.S. prices in line with what other countries pay.

Trump and the nation’s health care officials have touted these “most-favored nation” deals as the most effective means to getting pharmaceutical prices down, beyond even the power of the Medicare drug price negotiations already in place.

The key issue, health experts say, is that the public has had little visibility into these deals.

“The hard part, of course, is we don’t know exactly what’s in there,” said Spencer Perlman, managing partner and director of health research at the consultancy Veda Partners. The administration has held news conferences and put out fact sheets with bullet points, but experts have yet to review the fine print.

And it’s unclear how deep these actions will go, given that there are more than 2,500 pharmaceutical companies operating in the United States.

The first deal came early this month with Pfizer, which President Donald Trump said has agreed to lower U.S. drug prices and onshore a greater share of drug manufacturing in exchange for relief from certain tariffs. As part of the deal, the company agreed to make drugs available on the administration’s new “TrumpRx” direct-to-consumer medicine website and offer most-favored-nation pricing within Medicaid.

Ten days later, the administration struck a similar deal with AstraZeneca. And last week, the administration announced a deal with EMD Serono to lower the price of a widely used fertility drug, in exchange for tariff relief and expedited FDA review of another drug.

According to the White House, the Pfizer and AstraZeneca deals focus on lowering drug prices in Medicaid, which experts say likely isn’t a big lift for companies because the Medicaid price and the most-favored-nation price may be similar. If the goal is to lower costs for consumers, Medicaid copays are already considered low.

As for onshore manufacturing, companies may have already had plans to break ground on new domestic facilities.

“These are things they probably would have done anyway, or at least contemplated anyway,” Perlman said.

Several drug pricing experts and industry watchers said that without key details on negotiations and the multiple facets of the U.S. health care system, it’s hard to call the individual pharma deals a win.

Rachel Sachs, a professor of law at Washington University in St. Louis who was a senior adviser in the Office of General Counsel at the Department of Health and Human Services in 2022 when Medicare gained the option to negotiate prices for key drugs, said the public doesn’t know how enforceable these agreements are.

“It’s reasonable to ask the question whether confidential agreements are a good way to make public policy,” Sachs said.

She noted that stock prices for the companies spiked after announcements of the deals, “which is not typically thought to be a sign that prices will be markedly lower.”

Best method

Drug pricing has long been a target for Congress. The ability for Medicare to negotiate the price for several major drugs was included in Democrats’ 2022 reconciliation law.

Perlman said that if the administration is able to secure the most-favored-nation pricing for all parts of the U.S. market, it could result in savings for consumers.

“If you take it at face value, sure … that’s potentially better” than the Medicare price negotiations, Perlman said. But he said the lack of details makes that determination difficult, especially when it’s not clear that the drug companies are agreeing to most-favored-nation pricing across the board.

Brian Reid, who helms the health consultancy Reid Strategic, said his biggest question is how such MFN pricing would apply to Medicaid.

“Medicaid is not a huge channel, but it’s meaningful,” he said. “It’s important to states. And understanding the extent to which, what is MFN in those markets? How might that roll out?”

Sachs noted that the administration is using a “carrot and stick” approach, with the threat of tariffs and incentives like expedited review of drugs.

EMD Serono, which entered a deal with the administration for its fertility treatments, received one of the FDA’s inaugural National Priority Review vouchers for its infertility drug Pergoveris, which is already available in European markets.

FDA Commissioner Marty Makary earlier this year announced the new priority review voucher program, which awards vouchers for expedited review timelines for products it views as addressing a wide range of health priorities, including “addressing a large unmet medical need” and “delivering more innovative cures for the American people.”

What’s next?

The same dynamic could be playing out for obesity drugs.

The list of 2027 Medicare price negotiations includes popular GLP-1 medications used to treat obesity and diabetes. But CMS Administrator Mehmet Oz hinted earlier this month that the agency had something in the works on such drugs.

“We’re in the middle of a lot of action in that space, but you’ll be hearing more about it very soon,” Oz told CNBC’s Bertha Coombs at the Aspen Institute.

In response to a question from Endpoints News last week, Trump claimed that the price of obesity medications would go “much lower” than $150. Oz quickly jumped in and clarified that officials “have not negotiated those yet.”

“We’re going to be rolling these out over time,” Oz said. “The president will be happy with those results, and until he is, we’re not going to close those negotiations.”

Reid pointed out that the negotiations for obesity drugs Ozempic and Wegovy for 2027 are nearly complete, with the Nov. 1 deadline approaching for the companies and the administration to finalize the Medicare price.

“Even that’s confusing, because some of these drugs, the weight loss drugs, have been negotiated,” he said. “Just in some other part of the government.”

Sachs said a most-favored-nation deal appears to be in the works, but it’s possible that the administration could pilot some other kind of program.

The Washington Post in August reported that the Trump administration is planning an experiment through the Center for Medicare and Medicaid Innovation that would give Medicaid and Medicare Part D plans the option to cover GLP-1s.

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