The Federal Program That Lets You Buy Prescription Drugs From the White House

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The discounts look dramatic. But here’s what the White House doesn’t emphasize: for most people with insurance, using the program will cost more than their current plan.

How the Program Works

The program isn’t a government pharmacy. It’s more like a website that collects discount coupons and directs you to where you can use them. You visit the site, find your medication, download a coupon to your phone, and present it at checkout—or order directly from the manufacturer.

Some manufacturers created their own distribution systems for this. You’re paying cash, not using insurance, and the manufacturer handles everything from prescription verification to delivery.

The program emerged from an executive order Trump signed in May 2025 directing the government to establish pricing where U.S. costs match the lowest amounts paid by other developed countries. The administration sent letters to pharmaceutical manufacturers in July, saying: match international costs or face consequences.

Why Insurance Usually Beats Cash Pricing

When you pay cash through the program, those payments don’t count toward your deductible (the amount you pay before insurance kicks in) or your out-of-pocket maximum (your annual spending cap).

Say you have a $2,000 annual deductible. You buy two expensive treatments through the program, paying $400 monthly in cash. That’s $4,800 annually—and none of it counts toward your deductible. You still need to spend $2,000 through your insurance before coverage kicks in. You’ve paid twice: once for the cash purchases, again to satisfy your deductible.

Using insurance from the start means those same costs count toward your deductible. Once you hit $2,000, your coverage activates. You might pay a $35 copay instead of $200 cash. There’s an annual out-of-pocket maximum—often around $7,000 for individuals—that caps your total spending. The cash program has no such cap.

For most insured people, their plan’s negotiated rates and copay structures will cost less than cash amounts. A Medicare Part D beneficiary might pay a $5 generic copay or $35 for preferred brands. Someone with commercial coverage might have similar copays after meeting a modest deductible. Those structured benefits typically beat cash amounts—even discounted ones.

Who Benefits From the Program

The program makes sense for the uninsured. People with high-deductible health plans who haven’t yet met their deductible might save money on expensive treatments early in the year. People whose plans don’t cover certain prescriptions at all benefit—particularly obesity treatments like Wegovy, which many plans exclude.

The fertility treatment discounts represent genuine help for a population that typically pays entirely out-of-pocket. Gonal-F is listed at $168 per pen on TrumpRx. For someone pursuing IVF, who might need multiple cycles at $15,000-$20,000 each, saving $2,000 on prescriptions per cycle matters.

But fertility patients and the uninsured represent a small fraction of prescription users. The vast majority have coverage, and for them, the program functions more as a political statement than a practical solution.

Pharmacy Benefit Manager Reforms

Significant pharmacy benefit manager reforms change how the middlemen in pharmaceutical pricing operate.

Starting in 2028, pharmacy benefit managers must give all discounts from drug makers to insurance plans instead of keeping them. Currently, PBMs often pocket significant portions of these rebates—money that could reduce premiums or lower patient costs. The new law also stops the practice where PBMs charge insurance companies more than they paid pharmacies and pocket the difference.

Pharmacy benefit managers negotiate rebates from manufacturers, assemble pharmacy networks, and determine which prescriptions your insurance covers. When they keep rebates that should go to patients, charge companies more than they paid pharmacies, and hide how much they’re making, everyone’s costs rise.

The reforms also restrict PBM compensation in Medicare Part D, prohibiting payment structures linked to pharmaceutical costs. They mandate transparency reporting: pricing data for each treatment, information about which prescriptions are covered, pharmacy reimbursement details. These reforms will affect far more people than the cash program ever will.

The Medication Safety Problem

When you buy prescriptions through multiple channels—some through the cash program, others through your regular pharmacy, maybe a third treatment through a different discount program—no single pharmacist sees your complete list.

That fragmentation creates risk. Pharmacists check for interactions between treatments, duplicate therapies, inappropriate dosing based on age or kidney function, contraindications with your other conditions. When your records scatter across multiple systems, those safety checks fail.

The system works best when one healthcare provider—ideally your regular pharmacist—knows everything you’re taking and can spot problems before they harm you.

International Pricing Challenges

The concept sounds straightforward: people in the U.S. should pay what people in other wealthy countries pay. But this approach faces significant problems.

International prices can be manipulated. Many countries negotiate secret discounts that make their official prices look higher than what they pay. If the U.S. government tries to compel manufacturers to disclose those rebates, it might violate foreign confidentiality laws and damage diplomatic relationships.

If manufacturers face the choice between accepting deep U.S. cuts or withdrawing from weakly profitable overseas markets, many will exit foreign markets entirely. That reduces access to prescriptions in lower-income countries.

This approach gives control to foreign governments. The British National Health Service, for example, values health improvements differently than payers in the U.S. do. Other developed nations demonstrate willingness to deny patient access if offered amounts they consider excessive. If U.S. costs become anchored to the lowest international amount, U.S. prices would depend on what foreign governments decide to pay.

None of this means people here should keep paying three times what Canadians pay for identical prescriptions. But “charge us what you charge them” isn’t as simple as it sounds.

How the Program Compares to Existing Federal Programs

The federal government already runs several programs that negotiate or purchase prescriptions at discounted amounts. The VA’s success comes from its leverage as the single largest customer: as the biggest buyer for its beneficiary population, it has extraordinary negotiating power.

The cash program differs from these models. Unlike the VA, it doesn’t have doctors and hospitals coordinating your care or deciding which treatments you should use. It operates through executive action and voluntary manufacturer participation rather than legal power granted by Congress, creating questions about sustainability.

Legal Questions About the Program

It’s unclear whether the program has solid legal authority to operate. The May 2025 executive order directed HHS to “facilitate direct-to-consumer purchasing programs” at international amounts. But promoting private sales is different from the government buying and selling drugs itself.

If the program functions solely as a transparency tool and coupon aggregator—directing consumers toward manufacturers’ existing sales channels—it probably operates within executive authority over federal healthcare programs. If the government buys drugs, negotiates prices for federal programs, or acts as a buyer rather than sharing price information, legal questions arise about appropriations and authority requirements.

Naming a federal program after a sitting president raises questions about whether the program depends on one person’s authority rather than law. What happens when Trump leaves office? Does the program get renamed? Does it survive at all?

During Trump’s first term, federal courts in three states issued court orders temporarily blocking a similar rule for Medicare Part B. The Biden administration withdrew that proposal. The current approach sidesteps Medicare’s framework, but that doesn’t necessarily mean it’s on firmer legal ground—it hasn’t been challenged yet.

What Comes Next

The White House says the initial products represent “the beginning,” with more coming as additional manufacturers sign agreements.

The administration’s broader healthcare plan would require Congress to write international pricing into law. It would also allow more treatments to be sold over-the-counter. And it would end federal subsidy payments to insurance companies in favor of direct consumer subsidies, while requiring transparency about company profit margins and claim denial rates. None of that has advanced to formal legislative consideration. The PBM reforms passed, but the rest remains aspirational.

For Medicare, Medicaid, VA, and military healthcare beneficiaries, questions persist about how the cash program might integrate with existing benefits. Some policy observers envision these prices eventually becoming available through traditional coverage as a covered benefit option. This would resolve the current limitation where purchases don’t count toward deductibles or out-of-pocket maximums. But such integration would require Congress to change how Medicare and Medicaid handle prescription benefits.

Broader Context

The program makes visible something that’s been true for decades: people in the U.S. pay multiples of what other wealthy nations pay for identical prescriptions. The platform delivers real savings for the uninsured and high-deductible populations most likely to benefit from cash-pay alternatives.

For people with prescription coverage, the program mostly functions as political theater. Their existing benefits typically deliver lower out-of-pocket costs.

The PBM reforms received far less attention. Those reforms address systemic problems: PBMs keeping rebates that should go to patients, charging companies more than they paid pharmacies, and hiding how much they’re making. When those provisions take effect in 2028, they’ll affect far more people, reducing costs embedded in premiums and pharmacy benefit structures.

The program generates headlines and demonstrates action on pharmaceutical costs. The PBM reforms do the work of changing market structure. Both matter. But if you’re trying to figure out whether it will save you money, the answer depends entirely on whether you have coverage—and for most people, the answer is probably no.

Specific Patient Groups

People with chronic conditions requiring multiple prescriptions need to calculate total annual costs, not monthly amounts. Someone taking five maintenance treatments might find that three cost less through their plan while two cost less through the cash program—creating the fragmented purchasing pattern that complicates safety monitoring.

Seniors on Medicare Part D face particularly complex calculations. Part D includes catastrophic coverage that kicks in after $8,000 in total spending, dramatically reducing costs for expensive treatments. But cash purchases don’t count toward that threshold. A Medicare beneficiary who buys one expensive treatment through the program might delay reaching catastrophic coverage for their other prescriptions, ultimately paying more overall despite the single-product savings.

Some employer plans don’t count manufacturer discounts toward your deductible or out-of-pocket maximum—ask your plan if yours does. If your plan already excludes such programs, the cash program faces the same limitation—but at least you’re aware of it upfront rather than discovering it at year-end.

Political Sustainability

Programs that depend on a president’s order and companies’ willingness to participate might not last if circumstances change. Manufacturers signed agreements under threat of unspecified consequences. What happens if a manufacturer withdraws? The executive branch has limited tools to compel participation without congressional authorization.

Federal programs typically outlast individual administrations because they’re rooted in statute and institutional structures. The website exists because Trump ordered it into existence. When he leaves office—whether in 2029 or later—the program’s future depends on his successor’s priorities. A new administration could rebrand it, expand it, or eliminate it entirely.

The PBM reforms passed through the normal legislative process, with bipartisan support, and will be codified in federal law. They’ll survive regardless of who occupies the White House. The cash program operates in a more precarious position, dependent on continued executive commitment and manufacturer cooperation.

How to Decide If the Program Works for You

If you’re uninsured, the program offers genuine savings on expensive treatments. If you have a high-deductible plan and need costly prescriptions early in the year, it might make sense. If your plan excludes certain treatments entirely—particularly weight-loss or fertility options—the program provides access at lower amounts than you’d pay otherwise.

If you have traditional coverage with reasonable copays and an out-of-pocket maximum, calculate your total annual costs both ways: through your plan (counting toward your deductible and out-of-pocket maximum) versus through the cash program (not counting toward anything). For most insured people, the plan route costs less.

Having one pharmacist who knows your complete treatment list provides protection that fragmented purchasing eliminates. That protection has value, even if it’s hard to quantify.

The program exists. It helps some people. Make sure you’re one of them before you stop using your coverage.

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