A Year Later, Trump's Medicaid Drug Deal Still Hasn't Reached Patients

What Happened

On September 30, 2025, President Trump stood in the Oval Office with Pfizer's CEO and announced what he called a historic victory: pharmaceutical companies would slash Medicaid drug prices to match what other wealthy nations pay. "It's gonna have a huge impact on bringing Medicaid costs down like nothing else," he said. The centerpiece was TrumpRx, a discount website, alongside a promise that 26 drug companies would offer their full medication catalogs to Medicaid at "most favored nation" prices.

A year later, none of that has happened the way it was promised.

The agreements themselves remain secret. The Medicaid pilot program is still being built. Which drugs will actually be discounted is unknown. Worse, the program depends on both pharmaceutical companies and individual states choosing to participate, meaning patients in non-participating states may see no benefit at all. According to NPR, the drugs available through TrumpRx are already limited, and most people who use their insurance get a better price through their copay anyway.

What It Means for You

If you or someone you care for relies on Medicaid, this matters in concrete, painful ways. Medicaid covers 66 million Americans, seniors, people with disabilities, families living paycheck to paycheck. Their drug bills are already crushing: between 2019 and 2024, Medicaid's prescription drug spending grew 46%, reaching $46 billion in 2024 alone, according to the Kaiser Family Foundation.

That's your tax dollars. And it's money that could go to schools, roads, or staying in your own pocket, but instead it's flowing to pharmaceutical companies because prices in America are wildly out of line with what other wealthy countries pay.

The gap is real. The same insulin that costs $400 a month in the United States might cost $30 in Canada. A course of antibiotics that runs $200 here runs $20 in Germany. Americans subsidize the world's drug development, then pay the world's highest prices for it.

A year after the announcement, a Medicaid patient in most states can't point to a single drug that's actually cheaper because of this deal. The photo op happened. The results haven't.

The Bigger Picture

This isn't the first time a president has promised to take on pharmaceutical pricing. What's different here is the mechanism, and how little has actually changed.

Previous administrations pursued different strategies: negotiating directly with drug makers, allowing Medicare to negotiate prices (a policy Congress passed in 2023), or threatening to exclude high-priced drugs from federal programs. Those approaches had teeth. You can negotiate when you have the power to say no.

The Trump approach relies on voluntary participation from pharmaceutical companies, companies that have zero obligation to cut prices if they don't want to. A company can sign an agreement and still decide not to offer most of its drugs, or offer them only at minimal discounts. There's no enforcement mechanism mentioned, no penalty for non-compliance, no public record of what was actually promised.

Voluntary agreements sound nice at a press conference. In practice, they give the appearance of action while leaving the structure intact. Drug makers get the photo op. Patients get the waiting.

The voluntary opt-in requirement for states adds another layer of complexity. A state that opts in has to build new procurement systems, retrain staff, and negotiate with participating companies. Many states, especially smaller ones with limited healthcare infrastructure budgets, simply won't do it. Medicaid patients in those states are left out entirely.

Meanwhile, the secrecy is its own problem. If the agreements are real and beneficial, why hide them? Public pressure and transparency are the only tools citizens have to hold corporations accountable. A deal negotiated behind closed doors, with terms no one can see, is a deal shaped by whoever has the most power in the room, and spoiler: it's not the person choosing between insulin and rent.

Where This Goes

The midterm elections are weeks away, and drug prices will be a central issue. Trump is already touting this as a victory. But a year of delays, hidden details, and zero impact on actual patient bills is hard to call success, no matter what the headline says.

The question now is whether this pilot program will ever actually work, and if so, for whom. If it's genuinely operational by next year, if companies do offer meaningful discounts, if states do participate, and if patients actually see lower bills, it will have been worth the wait. But the track record so far, an elaborate announcement followed by a year of nothing, suggests we should be skeptical.

What's clear is that Americans still face the highest drug prices on earth in the wealthiest country on earth. A voluntary program with no transparency and no enforcement mechanism isn't going to fix that. It's going to be a placeholder while the underlying problem, a system where pharmaceutical companies can charge whatever they want, stays exactly as broken as it was before the photo op.