Democrats Move to Codify Trump’s Drug Pricing Order

This week, President Trump signed an Executive Order that aims to end the era of American patients paying more than anyone else for the exact same medications. The policy, called Most Favored Nation pricing, would tie U.S. drug costs to the lowest price paid in any other developed country.

It starts with Medicare Part B. That is the entry point because the federal government has clear authority there. But the order does not stop at Medicare.

It also directs HHS to work with pharmaceutical companies to offer direct to consumer programs that reflect the same lowest-in-the-world pricing. Think LillyDirect. Think NovoCare. These platforms already let people bypass insurance. But under this new framework, those DTC programs could soon offer drugs at the same price French and Canadian patients pay.

That could be a breakthrough. Especially for patients who pay cash for GLP-1s. Especially for people stuck in appeal processes. Especially for those who have been told no over and over again.

But it is not just about what was signed. It is about what came next.

The dust from the EO hasn’t even settled, but already Democratic Representative Ro Khanna introduced a bill to codify the Executive Order. Senator Bernie Sanders quickly joined in support. That means we now have a progressive-led push to make permanent a pricing policy launched from a Republican White House.

And that reveals something important.

For decades, Republican leadership has stood firmly against government involvement in drug pricing. Price controls have been a nonstarter. Many conservatives still believe that letting the market dictate prices is the only way to preserve innovation. That may explain why Trump’s Executive Order, though dramatic, has not been met with full-throated support from his own party.

Which is exactly why Democrats have stepped in to try to cement it.

If passed, the Khanna bill would give Most Favored Nation pricing the force of law. It would protect it from legal sabotage. It would outlive any single administration. And it would mark a real shift in how Americans pay for prescription drugs.

But MFN isn’t without some concerns that we have highlighted this week, as well.

If profit margins in the U.S. drop, pharma companies may choose to sell elsewhere first. That could worsen shortages for medications already in tight supply, including GLP-1s. And if direct to consumer becomes the new standard, local pharmacies may continue to be pushed out. Many already are. These manufacturer-run programs cut the pharmacist out entirely, offering no in-person care, no local pickup, and no relationship with the providers who have long filled that role.

At the same time, this is a direct challenge to the PBM system. For years, pharmacy benefit managers have profited off inflated list prices, pocketing rebates and pushing costs downstream. This Executive Order, and the legislation that follows, is a clear attempt to bypass that system entirely.

The momentum is not just federal. My home state of Iowa just passed meaningful PBM reform this week. States are stepping up while Washington fights through the gridlock.

#PBMReform

So where does this leave us?

We are watching the first real bipartisan movement in years to rebalance the cost of innovation and care. Whether you are on GLP-1s, or just someone who is tired of paying more for the same pill your friend in Germany gets for a third of the cost, this moment matters.

It is not perfect. It is not final. But it is movement. And movement is rare.

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