The Trump administration is preparing to launch TrumpRx.coman initiative aimed at lowering drug costs by aggregating direct-to-consumer access to branded prescription medications at discounted cash prices.
The promise is seductive: lower prices on brand-name medications, available to anyone willing to bypass their insurance and pay out of pocket.
But for most Americans, this initiative represents not a solution to our prescription drug price dilemma, but rather a distraction from it. In fact, TrumpRx won’t help most Americans because it is designed for cash-paying, uninsured patients rather than the roughly 85% of Americans with prescription drug insurance coverage. For insured people, existing pharmacy benefits remain cheaper, and using TrumpRx may prevent payments from counting toward insurance deductibles and annual out-of-pocket maximums.
The fundamental flaw in the TrumpRx model lies in a misunderstanding — or perhaps a willful misrepresentation — of how most Americans pay for their prescription medications. Most insured people pay far less out of pocket when using their insurance coverage than they would by paying “discounted” cash prices, even when those prices are subsidized by manufacturers.
The illusion becomes even starker when we consider the realities of America’s aging population. The average American over age 65 fills or refills an average of 32 prescriptions per yearwith 20% taking more than 10 unique medications per year. These seniors live on a median household income of roughly $56,680 per yearaccording to 2024 data — often fixed income from Social Security and modest savings. Importantly, most choose to purchase Medicare Part D drug benefits and thus have government support on their annual out-of-pocket costs for prescription drugs.
Now consider a common but hypothetical scenario for older Americans: A patient with diabetes and high cholesterol needs two brand-name medications: Januvia and Repatha. Through insurance, they might pay a $35 copay for each drug per month ($840 per year). The TrumpRx website will offer Januvia for diabetes at $100 per month and Repatha for cholesterol management at $239 per month — a “discount” from existing manufacturer list prices of $330 and $573 per month, respectively ($4,068 per year). Paying cash requires an additional $3,228 out-of-pocket, or nearly 6% of their total income. For seniors already choosing between medications and groceries, this isn’t a discount. Using TrumpRx would represent the equivalent of a tax on those least able to afford it.
The mechanics of prescription drug insurance coverage reveal why this matters. When patients use insurance, they make use of insurance negotiated rates, and their spending counts toward annual deductibles and out-of-pocket maximums. These benefits may not be accessible when patients pay cash via TrumpRx. A family might hit their out-of-pocket maximum by midyear using insurance, after which their insurer pays 100% of the prescription cost for the rest of the year. Under TrumpRx, the family would pay full freight all year long, with no ceiling on their out-of-pocket spending.
A Wednesday Federal Trade Commission settlement with Express Scripts includes a provision that Express Scripts must “provide covered access to TrumpRx as part of its standard offering upon relevant legal and regulatory changes.” The settlement is subject to a 30-day public comment period. It is unclear whether employers, health insurers, Medicare Part D plans, and their contracted PBMs, like Express Scripts, will amend their prescription drug benefits to allow cash purchases outside of their retail pharmacy networks to count toward annual deductibles and out-of-pocket maximums.
What remains clear is that the prescription benefit design that allows patients to pay a fractional co-payment at the point-of-sale will not apply to cash-based TrumpRx purchases.
So, who might actually benefit from TrumpRx? The uninsured, those with high-deductible health insurance plans, and those patients with high incomes who already pay cash for medications not typically covered by insurance, like drugs for weight loss, cosmetic Botox, or fertility treatments. For the roughly 15% of Americans with no or marginal prescription drug coverage, any cash price reduction from the full list price will be meaningful. The larger issue remains, however: The vast majority of Americans will not benefit from TrumpRx.
The real winners in this arrangement are the pharmaceutical manufacturers. These companies have long offered some form of direct-to-consumer access to medications — often framed as patient assistance programs — that allow them to bypass the restrictions placed on access from insurers and pharmacy benefit managers. By routing patients away from insurance to a cash market, the manufacturers preserve their ability to maintain higher prices while appearing magnanimous through selective discounting. It’s a strategy that protects margins while further fragmenting the collective bargaining power that insurance pools are designed to provide.
Beyond the financial implications lies an even more troubling dimension: patient safety. When Americans, especially seniors, fill prescriptions through traditional pharmacies, pharmacists serve as a critical safeguard, reviewing medication profiles for dangerous interactions, flagging duplicate therapies, and counseling patients on proper use. This oversight has prevented countless medical errors and adverse eventssome of which could certainly result in harm and even death.
But when patients purchase medications directly from manufacturers through TrumpRx, they fragment their medication and health records across multiple sources. No single pharmacist sees the complete picture of what medications a patient is taking under TrumpRx. A person buying a blood pressure medication through TrumpRx, a cholesterol medication at a retail pharmacy, and a diabetes medication through another direct-to-consumer program creates a dangerous information vacuum. The risk of harmful drug interactions, duplicate therapies, or dangerous dosing errors multiplies exponentially when the pharmacist’s role as patient advocate in health care is diminished.
Ultimately, TrumpRx is not a serious attempt to fix the systemic issues that plague access to drugs at a price that is fair for all Americans. Americans do not need another government website; we need a government that is willing to fix the system itself — through fair and transparent price negotiations that recognize a drug’s value to society, meaningful patent reform, and more efficiently designed insurance coverage that ensures every American can afford the medications they need.
Sean D. Sullivan, Ph.D., is professor of health economics and policy and former dean of pharmacy at the University of Washington. Ryan N. Hansen, Pharm.D., Ph.D., is professor of health economics and policy and chair of the Department of Pharmacy, University of Washington.
