A Price-Control System That Controls Almost Nothing

Robert F. Kennedy Jr. had a simple explanation for why the administration was claiming drug price reductions of 600 to 1,500 percent ^[1]. A price cut of more than 100 percent is not a deep discount; it is a negative price — a company paying customers to take its medicine. Kennedy's answer to the arithmetic was that there is more than one way to do the math.

I think that means companies should be paying you to take their drugs. — Elizabeth Warren

There are not two ways to calculate a percentage reduction. There is one, and it cannot exceed 100. The claim was the tell: this is a price-control system whose numbers are for display, not for checking. The system itself is real, and it is built on the tariff. In August 2025 the administration announced a Most Favored Nation drug pricing policy and a tiered tariff on imported pharmaceuticals that could climb to 250 percent over 18 months, with a compliance deadline for major firms ^[2]. The threat did the work. By December, nine companies — Amgen, Bristol Myers Squibb, GSK, Merck, Sanofi — had accepted MFN pricing for Medicaid and cuts of up to 70 percent off list prices, in exchange for a three-year tariff exemption and FDA priority vouchers, alongside $150 billion in pledged U.S. investment ^[3]. Democrats asked whether the exemption was a quid pro quo. It was, in the plainest sense: the tariff was the stick, the exemption the carrot, and the price commitment the price of admission. By April, 17 companies representing 80 percent of the branded drug market had signed, with Regeneron the last holdout ^[4]. The discounts reached consumers through a government portal, TrumpRx, which by June listed more than 800 drugs ^[5]. But the portal is not a price control. It is a search engine and coupon aggregator that sends users to partner pharmacies, and the deepest discounts are often unavailable to Medicare, Medicaid, VA, and TRICARE patients because of federal anti-kickback rules ^[6]. The people the program is meant to help — the insured, the elderly, the poor — are the ones who cannot use it. Senator Elizabeth Warren described what the portal actually is.

conduit for Big Pharma to steer consumers to expensive brand-name drugs when cheaper generics are available. — Elizabeth Warren

The price control operates on a narrow slice: cash-paying consumers who find the portal. And even on that slice, the control is thin. In April, a report from Senator Bernie Sanders found that 15 of the 16 drugmakers in the program had raised list prices on 337 drugs since January 2025, including cancer and MS treatments ^[7]. Sanders put the finding plainly.

Unfortunately, despite President Trump’s rhetoric, prescription drug prices in America have only gone up, not down, since he was elected. — Bernie Sanders

The White House answered that the report measures list prices, not what patients pay. That is true, and it is the point: the discounts live on the portal, while the list prices that anchor the rest of the market kept rising. Then the template spread. Volkswagen negotiated down its 27.5 percent import tariff in exchange for U.S. investment and possible Audi production ^[8]. In December 2025 the administration said it would call UnitedHealth, Aetna, and Cigna to pressure them to lower premiums ahead of the ACA subsidy expiration — the same voluntary-negotiation model, government leverage in exchange for a corporate price commitment ^[9]. The tariff had become a general-purpose price lever, applied to cars and insurance premiums the way it was applied to pills. The irony sits at the end of the chain. In January, Fed Chair Jerome Powell attributed the elevated inflation to the tariffs themselves, saying tariff-induced inflation was expected to peak in mid-2026 ^[10]. Powell was direct about where the pressure came from.

there's an expectation that sometime in the middle quarters of the year we'll see tariff inflation topping out. — Jerome Powell

The cost pressure the price deals are meant to relieve is, in significant part, pressure the tariffs created. The portal shows a lower number on a screen for the people who can reach it. The list prices kept rising. The gap between the two is where the price control actually lives.