Editor’s Note: This perspective was originally published in Newsweek on Feb. 26, 2026.
For years, the drug-pricing debate in Washington has revolved around a familiar question: how much should the government intervene to lower costs? Democrats favored direct negotiation, while many Republicans warmed to international reference pricing. Both approaches assumed that Washington would ultimately set the terms. A series of recent policy moves, however, suggests the Trump administration may be testing a different strategy, one aimed less at dictating prices than at forcing them to compete.
This approach reflects a governing perspective that could be described as favoring “Big Patient.” Health care policy is typically shaped by powerful institutional voices—insurers, pharmaceutical benefit managers (PBMs), drug manufacturers, hospital systems and physician groups—each advancing priorities that invite accusations of self-interest. By contrast, the administration’s recent drug-pricing actions signal an effort to shift leverage toward consumers themselves.
The clearest example is TrumpRx, unveiled this month as part of an effort to foster a more competitive marketplace for prescription drugs—one in which consumers may gain access to lower prices without relying solely on government rate-setting or opaque intermediary negotiations.
At the heart of the initiative is a government-backed website offering more than 40 high-demand prescription drugs at steeply discounted cash prices through participating pharmacies. The platform is poised to expand, incorporating generics and additional medications in the months ahead.
For the uninsured, those navigating health savings accounts or enrollees facing coverage gaps in their insurance plans, TrumpRx represents a lifeline. It empowers patients to take the reins of their drug expenditures, bypassing the opaque machinations of intermediaries. In some cases, prices could rival those negotiated by Medicare itself—and, in rare but telling instances, undercut what insured patients might pay through their own plans.
A critical limitation—that TrumpRx purchases do not currently apply toward insurance deductibles or out-of-pocket maximums—is on the cusp of resolution. Coinciding with the program’s launch, the Federal Trade Commission secured a settlement with Express Scripts, the home-delivery pharmacy giant, over alleged violations of the FTC Act. Under its terms, Express Scripts must credit TrumpRx out-of-pocket costs toward patients’ deductibles and caps, pending regulatory adjustments to shield these prices from Medicaid “best price” mandates and 340B program calculations.
The settlement also imposes stringent transparency obligations on Express Scripts, aligning closely with forthcoming U.S. Labor Department rules that will bind all PBMs to similar standards.
Complementing this move, President Trump signed an appropriations bill imposing fresh curbs on PBM practices. These entities, which arose in the 1960s amid expanding federal involvement in health care, initially served as a check on rising costs and regulatory complexity. Yet over time, they have shielded patients from true medication prices, exacerbating market distortions and inflating overall spending.
The new law mandates that PBMs furnish group health plan sponsors with granular data on drug expenditures, compelling them to defend their network designs and benefit structures. Enrollees, too, will receive detailed breakdowns of coverage, costs and utilization—equipping consumers to make savvy choices about their benefits.
Yet expanding patient power is not without hazards. There is one area in which the Trump administration can deliver sorely needed oversight. In a marketplace already strained by soaring drug costs, the rise of compounded medications—custom-mixed alternatives to branded therapies—presents a seductive but perilous shortcut. Telehealth giants such as Hims & Hers Health have capitalized on this lack of regulation, peddling knockoff versions of blockbuster GLP-1 drugs such as Novo Nordisk’s Wegovy at a fraction of the price, exploiting regulatory loopholes amid shortages. This shadow industry demands stricter oversight, as it erodes the foundations of pharmaceutical innovation and distorts fair competition.
Developing a new drug like semaglutide requires billions in R&D, rigorous FDA trials and patent protections to recoup investments. Compounded variants bypass these hurdles, mass-producing unapproved copies without comparable safety data or clinical validation. The result? Pharma firms, facing eroded revenues from patent circumvention, may curtail risky bets on future breakthroughs—stifling advancements in obesity, diabetes and more.
Market tilting exacerbates the issue. While branded drugs endure stringent scrutiny, compounders operate in gray zones, potentially introducing impurities, dosing inconsistencies, subpar efficacy and suspect sourcing. Patients lured by affordability risk health hazards, while innovators shoulder disproportionate burdens. Regulation must close these gaps, enforcing FDA standards on mass compounding to safeguard incentives and level the playing field. Without it, America’s drug ecosystem risks devolving into a race to the bottom, where shortcuts trump science.
Trump has already instituted reforms across multiple departments that shift power toward patients, sidelining the vested interests of insurers, pharmaceutical companies, hospitals and lobbyists. In the short term, Wall Street may greet these with skepticism, viewing health care through the lens of investment returns rather than human need. But the president rightly grasps that ordinary Americans are not hedge funds or day traders—they are working families who deserve reliable, affordable medicine. In delivering on this front, he advances his vision to “Make America Healthy Again.”
Big Patient may prevail after all.
