In a sweeping set of moves aimed at tackling the soaring cost of prescription drugs in the United States, President Donald Trump and billionaire entrepreneur Mark Cuban have launched ambitious initiatives that could reshape the pharmaceutical landscape. The dual-pronged approach—combining bold executive action with private sector innovation—has sparked intense debate among patients, industry leaders, and policymakers alike.
On December 1, 2025, President Trump announced his intention to sign an executive order implementing a "most favored nation" (MFN) pricing policy for prescription drugs. In a statement posted on Truth Social, Trump declared, "I will be instituting a MOST FAVORED NATION’S POLICY whereby the United States will pay the same price as the Nation that pays the lowest price anywhere in the World." According to Trump, this policy could slash drug prices by 30% to 80% "almost immediately." He emphasized the urgency of the issue, pointing out that Americans spend $400 billion annually on prescription drugs—often triple what other countries pay for the same medications. "For many years the World has wondered why Prescription Drugs and Pharmaceuticals in the United States States of America were SO MUCH HIGHER IN PRICE THAN THEY WERE IN ANY OTHER NATION," Trump wrote, adding that the gap was "very embarrassing because, in fact, there was no correct or rightful answer."
Trump’s MFN policy revives a controversial proposal from his first administration that would have tied U.S. drug prices to the lowest prices paid by peer nations. That earlier attempt was blocked by federal courts and later rescinded during the Biden administration. However, the legal landscape shifted in 2022 with the passage of the Inflation Reduction Act (IRA), which granted Medicare the authority to negotiate prices for a limited set of high-cost drugs. This crucial change removed a major obstacle, allowing Trump’s new executive order to move forward.
While many Americans have cheered the prospect of lower drug prices, experts and industry insiders have raised concerns about potential downsides. According to CNN, some analysts warn that the MFN policy could limit patient access to certain medications, depending on how it is structured. The pharmaceutical industry, for its part, is gearing up for a fierce fight, arguing that sweeping price controls could stifle innovation and reduce the incentive to invest in new treatments.
Meanwhile, Mark Cuban, the outspoken billionaire and owner of the online pharmacy Cost Plus Drugs, has made a direct appeal to the Trump administration to eliminate the hefty regulatory fees that pharmaceutical companies must pay to bring generic drugs to market. According to Reuters, Cuban identified the Food and Drug Administration’s (FDA) approval fees—currently nearly $360,000 per application—as a major barrier to domestic manufacturing of affordable medications. "Pursuing approval for hundreds of different drugs could require tens of millions of dollars in regulatory fees alone," Cuban explained, "fundamentally undermining the economic rationale for relocating manufacturing operations from overseas facilities to domestic plants."
Cuban’s Cost Plus Drugs already operates a major compounding pharmacy in Dallas and stands ready to expand its facilities to begin manufacturing generic drugs within about a year—if the administration agrees to waive the FDA fees. The planned expansion would focus on high-cost generics, including treatments for rare diseases that can cost hundreds of thousands of dollars annually, as well as more commonly used medications priced at $100 or more. Cuban noted that manufacturing inexpensive generics already available for just a few dollars at major retailers would not make economic sense, but targeting pricier generics could deliver substantial savings to patients while maintaining profitability.
The business model at Cost Plus Drugs is built around radical pricing transparency. The company sells medications at just a 15% markup over acquisition costs, plus standard pharmacy fees, and aims to cut out intermediaries who often inflate prices. This approach has delivered the most dramatic savings to uninsured and underinsured patients, who typically face the steepest out-of-pocket costs. Cuban has been a vocal critic of the opaque pricing practices that pervade the healthcare industry, especially the role of pharmacy benefit managers and other middlemen. He argues that these players extract substantial profits while driving up costs for consumers.
To further its mission of transparency, Cost Plus Drugs plans to launch a new initiative that will publish its contracts with healthcare providers, creating a benchmark for others in the industry. Earlier this year, the company also joined TrumpRx, a government-backed website designed to reduce prescription drug costs by connecting patients directly with manufacturers and bypassing traditional distribution channels.
While Cuban’s proposal to waive FDA fees faces an uncertain path amid competing priorities and industry concerns, his track record of disrupting established business models—and his alignment with Trump’s push for domestic manufacturing—could give the initiative momentum in Washington.
At the same time, the Trump administration’s Centers for Medicare and Medicaid Services (CMS) has been implementing the landmark provisions of the Inflation Reduction Act. On December 4, 2025, CMS announced the final prices for the second round of 15 drugs negotiated under the IRA, including Novo Nordisk’s blockbuster weight loss drugs Wegovy, Ozempic, and Rybelsus (semaglutide). These drugs alone accounted for $42.5 billion in Medicare expenditures in 2024—about 15% of all Part D drug costs. The negotiated price reductions ranged from 38% to 85%, with Merck’s Janumet XR (metformin + sitagliptin) seeing the steepest cut. The new prices will take effect on January 1, 2027, and are expected to save Medicare beneficiaries $685 million in out-of-pocket costs.
However, the interplay between the IRA’s negotiated prices and the Trump administration’s MFN executive order has introduced new complexity. According to Pharmaceutical Technology, in early November 2025, Novo Nordisk reached an MFN agreement with the Trump administration for its weight loss therapies, offering Wegovy to Medicare for $245 per month starting in 2026—lower than the $274 price negotiated under the IRA. CMS has clarified that MFN prices will supersede those negotiated under the IRA, signaling that future MFN deals could override the outcomes of ongoing IRA negotiations. By February 1, 2026, another 15 drugs will be announced for the next round of IRA price negotiations.
The pharmaceutical industry has not taken these changes lightly. The Pharmaceutical Research and Manufacturers of America (PhRMA) has called the IRA’s price negotiations “price setting” and warned of negative long-term impacts on research and development. Multiple lawsuits challenging the IRA are still pending, though with little success so far. Industry critics argue that, despite the headline savings, patients have yet to see significant reductions in out-of-pocket costs, and warn that aggressive price controls could ultimately limit access to new and existing therapies.
As the dust settles, the battle over drug pricing in America is far from over. With the Trump administration pushing for sweeping reforms and entrepreneurs like Mark Cuban offering innovative solutions, the coming months could bring lasting changes to how Americans access—and pay for—their medicines.
