What TrumpRx Could Mean for Medication Access: What We Know So Far

Written by La Lune Psychiatry|Medically Reviewed by Elita Wong, PMHNP-BC

TrumpRx, announced on September 30, 2025, builds on the May 2025 executive order “Delivering Most-Favored-Nation Drug Pricing to American Patients,” aimed at lowering prescription drug prices.

A key concept in this initiative is the administration’s use of “Most Favored Nation” (MFN) pricing. In international trade, MFN status typically means a country gets the best price or trade terms that a nation offers to any trading partner. Applied to medications, the Trump administration is using MFN pricing to mean that drug manufacturers would offer U.S. patients the lowest price they charge in any other comparable country.

In practice, the intent is to align U.S. drug prices more closely with those in countries that use centralized negotiation to secure lower costs. If fully implemented, the idea is that MFN pricing could bring American drug costs closer to those seen in Europe, Canada, and other nations where governments negotiate prices directly.

The broader goal of the Executive Order is to reduce the cost burden of medications by driving down manufacturer pricing for drugs sold in the U.S. (The United States Government, 2025a). One piece of that strategy is TrumpRx, a forthcoming direct-to-consumer purchasing platform scheduled to launch in 2026.

How will TrumpRx work?

The goal of the TrumpRx website is to provide direct purchasing access to Americans seeking prescription medication at negotiated lower prices. The TrumpRx website will connect visitors to manufacturer websites for direct purchase of medication (with a prescription), at prices that may be as much as 50% lower. Purchases through TrumpRx will not go through insurance, but will instead be out-of-pocket purchases, so price advantages and disadvantages will vary depending on insurance coverage (Lupkin, 2025)

Pfizer, Eli Lily, AstraZeneca, and Novo Nordisk have already negotiated prices for medications to be made available via the TrumpRx website, and the Trump administration has stated it will continue to expand negotiations with manufacturers (The United States Government, 2025b, 2025c). Pfizer has also stated that they plan to sell new medications for the same prices in the US as they charge in other countries (Lupkin, 2025).

In the US, the government has typically allowed pharmaceutical prices to be governed by market forces, instead of negotiating for set prices (with some exceptions). In other countries, the government usually negotiates set prices for medications. One of the goals of TrumpRx is to more closely align pricing in the US with pricing in other countries for the same products.  (Lupkin, 2025). 

How will TrumpRx impact psychotropic medication prices?

So far, we don’t have further information on how TrumpRx will impact psychiatric medication prices. We know that some of the manufacturers that have current TrumpRx agreements do produce psychotropic medications, but we don’t currently have a full list of medications that will be available through TrumpRx, nor do we know exactly how many manufacturers will participate.

The current medications we know will be included are:

• GLP-1 receptor agonists & dual-agonists (Ozempic, Wegovy, Mounjaro & Zepbound)

• Fertility Medications for IVF (Gonal-F)

• Migraine/CGRP Pathway (Emgality)

• Non-GLP-1 Diabetes Medications (Trulicity Insulin products from Novo Nordisk)

• Anti-Inflammatory/Autoimmune Medications for Dermatology/Immunology (Eucrisa & Xeljanz)

• Acute Migraine Treatment (Zavzpret)

• Respiratory Therapies (Bevespi Aerosphere, Breztri Aerosphere, and Airsupra)

These are widely-used medications, but none are psychotropic medications (The United States Government 2025b, 2025c).

It seems likely, though not guaranteed, that some psychotropic medications will be available through TrumpRx at reduced out-of-pocket prices. TrumpRx is also part of a broader approach that includes reduced prices for Medicare and Medicaid recipients, which may also include psychotropic medications.

What are the limits of TrumpRx?

While TrumpRx has the potential to lower out-of-pocket costs for some patients, several limitations should be acknowledged:

1. Insurance may still be cheaper.

For insured patients—particularly those meeting deductibles or using manufacturer copay programs—the TrumpRx price may not be the lowest option.

2. It may replicate discounts already offered elsewhere.

Many manufacturers already provide direct-to-consumer discounts (e.g., Lilly Direct). It remains unclear whether TrumpRx will offer additional savings or simply centralize access to existing ones (McGrath, 2025).

3. We do not yet know which medications will be included.

The list of participating manufacturers is growing, but the final medication selection is not known—making it difficult to predict the true benefits.

The Current State of Mental Health Medication Prices and Access: A Highly Variable Landscape

What informs the cost and availability of mental health medication?

TrumpRx is part of a larger effort by the Trump administration to decrease medication prices and increase medication access for Americans. Understanding the barriers can help us better grasp how TrumpRx can help, and where it may fall short. 

Health insurance companies use “prior authorization” as a cost-saving measure. When a patient tries to fill a prescription for certain medications (which medications are predetermined by the insurer, but not disclosed until the prescription triggers a prior authorization requirement), the insurance company will deny financial coverage for the prescription until the prescriber reaches out with additional documentation to prove the prescription is the best option for the patient. 

Prior authorization is a barrier to access for patients who cannot afford out-of-pocket medication prices and demands substantial time and effort from prescribers, usually for completely appropriate treatments (Gerlach, 2024). Lowering the prices of out-of-pocket options with a project like TrumpRx can increase access to these medications for some who want to bypass prior authorizations. However, this will not benefit all patients, especially those relying on insurance subsidies.

Here are some examples of out-of-pocket costs for one-month supplies of non-generic psychotropic medications (prices accurate as of November 2025 per GoodRx): 

• Viibryd: $439.67

• Trintellex: $622.77

• Vraylar: $1823.11

• Caplyta: $2053.00

• Qelbree: $454.37

• JornayPM: $568.98

These costs remain out of reach for many patients—highlighting the urgent need for price reform.

Why Are Medications So Expensive? A Look at the FDA Approval Process

The drug development and approval process at the FDA is rigorous and thus, expensive. From initial research and clinical trials to working with regulators through the review and approval process, developing a new psychotropic drug can take years, even with substantial budgets.

To encourage manufacturers to take the financial risk of developing new medications, the FDA provides exclusive rights to manufacture new drugs. These patents typically last around 20 years, with different lengths (including increased duration of exclusivity) depending on different approvals.

When a manufacturer has exclusive rights to a medication, it can charge prices that help it recoup the cost of the research, development, and approval process. This increases the price of the medication, and also can reduce its availability; when only one manufacturer is available, and they have challenges meeting demand, supply issues can result in shortages (Center for Drug Evaluation and Research 2022a). 

Case Example: Vvyanse and the Impacts of Generics

Vyvanse (lisdexamfetamine) is an illuminating case study showing the pricing and availability differences between generic and name-brand medications.

Lisdexamfetamine is a medication used to treat ADHD and binge eating disorder, and until 2023, it was only available as a brand-name medication, Vyvanse. In 2023, the 20-year FDA patent for Vyvanse expired, and the FDA then approved several additional manufacturers who applied to make and market generic lisdexamfetamine.

These manufacturers can offer lisdexamfetamine at a lower price because they did not have to bear the initial cost burden of research and development. They have to go through an FDA approval process, but because they are using pre-approved products and processes, it is much faster and less expensive than the initial approval process for Vyvanse. 

This expansion in the number of manufacturers not only reduced the price but also increased access to a medication that was already experiencing a shortage (Schimelpfening, 2023). Vyvanse (name brand) currently costs around $400/month without insurance, and generic lisdexamfetamine costs as little as $50/month without insurance, an obvious cost advantage (GoodRx, 2025). 

If TrumpRx reduces name-brand pricing before generics hit the market, more patients could gain earlier access to effective treatments.

Past Efforts to Reduce Drug Costs: Successes and Limitations

Past administrations have made some inroads in reducing medication prices and increasing access, but these efforts have often included trade-offs to balance industry interests with those of the public.

The Affordable Care Act (2010) and the Inflation Reduction Act (2022)

In 2010, President Obama signed into law what is currently known as the Affordable Care Act (Rangel, C., 2010). This piece of legislation changed health insurance access and pricing in the United States, including significant subsidies for prescription drug coverage. However, the ACA left in place the existing prohibition on Medicare negotiating drug prices — a policy originally set by the 2003 Medicare Modernization Act — in part to maintain support from pharmaceutical industry stakeholders.

In 2022, the Biden administration and Congress passed the Inflation Reduction Act. This now lets Medicare negotiate drug prices, with a cap on the number of medications that can be price-negotiated per year (The United States Government, 2024). These negotiations have commenced under the Trump administration and are already settled for 2026 and 2027 (CMS, 2025).

Price caps

Price caps on prescription medications are uncommon in the United States. Insulin is one of the few exceptions.

• In 2020, the Trump administration introduced a voluntary $35 monthly insulin cap for certain Medicare Part D plans. This meant Medicare plans could choose to participate, but were not required to do so.

• In 2023, the Biden administration strengthened this policy by establishing a mandatory $35 monthly insulin cap for all Medicare plans, ensuring that every Medicare enrollee would pay no more than $35 per month for insulin (Kffjuliettec, 2025).

This progression—from a voluntary model to a required, system-wide cap—made insulin one of few medications in the U.S. with a federally enforced limit on patient out-of-pocket costs.

Tariffs

The current Trump administration has tried to use tariffs to establish trade deals that incentivize and increase investment in US pharmaceutical manufacturing. The impacts on medication pricing are unknown, largely because different tariffs have been announced, renegotiated, and postponed depending on varying geopolitical factors, so it will take time before the effects are fully understood (Elçi, 2025). 

Tariffs are also a component of the “Delivering Most-Favored-Nation Drug Pricing to American Patients”, as an attempt to incentivize participation in the initiatives put forth by the administration  (Lupkin, 2025)

Final Thoughts from La Lune Integrative Psychiatry

As we wait for clearer information about how TrumpRx will affect medication access, especially for the psychotropic treatments so many people depend on, one thing remains certain. National policy changes have the ability to shift prices, adjust availability, and reshape the landscape of mental health care.

At La Lune Integrative Psychiatry, we advocate for affordable access to healthcare, including prescription medications recommended by licensed providers. We also strongly support mental health parity—ensuring that mental health care is valued and covered as fully as physical health in policy and insurance plans.

Sources:

1. Center for Drug Evaluation and Research. (2022a). Drug development & approval process. U.S. Food and Drug Administration. https://www.fda.gov/drugs/development-approval-process-drugs

2. CMS. (2025, November 26). Selected drugs and negotiated prices. CMS.gov. https://www.cms.gov/priorities/medicare-prescription-drug-affordability/overview/medicare-drug-price-negotiation-program/selected-drugs-negotiated-prices

3. Elçi, A. (2025, November 26). Timeline: How us president trump upended the pharma industry in 2025. SWI swissinfo.ch. https://www.swissinfo.ch/eng/drug-pricing/timeline-how-us-president-trump-upended-the-pharma-industry-in-2025/90348148

4. Gerlach, J. (2024, January). Prior authorization: A barrier to mental health recovery. Psychology Today. https://www.psychologytoday.com/us/blog/beyond-mental-health/202401/prior-authorization-a-barrier-to-mental-health-recovery

5. GoodRx. (2025). Vyvanse 2025 prices, Coupons & savings tips - goodrx. https://www.goodrx.com/vyvanse

6. Kffjuliettec. (2025, August 9). The facts about the $35 insulin copay cap in Medicare. KFF. https://www.kff.org/medicare/the-facts-about-the-35-insulin-copay-cap-in-medicare/#:~:text=What%20did%20the%20Biden%20Administration,July%201%20for%20Part%20B).

7. Lupkin, S. (2025, September 30). President announces Trumprx website for drugs, and pricing deal with Pfizer. NPR. https://www.npr.org/sections/shots-health-news/2025/09/30/nx-s1-5558432/drug-prices-trumprx-pfizer

8. McGrath, C. (2025, October 16). What’s TrumpRx, and how does it compare to other DTC options? Healthcare Brew. https://www.healthcare-brew.com/stories/2025/10/16/trumprx-compare-other-dtc-options

9. Rangel, C. B. (2010, March). Text - H.R.3590 - 111th congress (2009-2010): Patient Protection and Affordable Care Act | congress.gov | library of Congress. https://www.congress.gov/bill/111th-congress/house-bill/3590/text

10. Schimelpfening, N. (2023, September 5). Generics of popular ADHD drug vyvanse get FDA approval. Healthline. https://www.healthline.com/health-news/fda-approves-generics-adhd-medication-vyvanse#How-long-it-will-take-for-generic-Vyvanse-to-become-available

11. The United States Governement. (2024, February). Interested parties memo: President Biden takes on Big Pharma and is lowering prescription drug prices | The White House. National Archives and Records Administration. https://bidenwhitehouse.archives.gov/briefing-room/statements-releases/2024/02/01/president-biden-takes-on-big-pharma-and-is-lowering-prescription-drug-prices/

12. The United States Government. (2025a, May 12). Delivering most-favored-nation prescription drug pricing to American patients. The White House. https://www.whitehouse.gov/presidential-actions/2025/05/delivering-most-favored-nation-prescription-drug-pricing-to-american-patients/

13. The United States Government. (2025b, September 30). Fact sheet: President Donald J. Trump announces first deal to bring most-favored-nation pricing to American patients. The White House. https://www.whitehouse.gov/fact-sheets/2025/09/fact-sheet-president-donald-j-trump-announces-first-deal-to-bring-most-favored-nation-pricing-to-american-patients/

14. The United States Government. (2025c, November 6). Fact sheet: President Donald J. Trump announces major developments in bringing most-favored-nation pricing to American patients. The White House. https://www.whitehouse.gov/fact-sheets/2025/11/fact-sheet-president-donald-j-trump-announces-major-developments-in-bringing-most-favored-nation-pricing-to-american-patients/