"For the first time in 51 years, the cost of prescription drugs actually went down."
— Donald Trump, State of the Union address, February 4, 2020. PolitiFact rating: Mostly False.Trump's basis for the claim was a narrow reading of a federal drug price index that showed a slight overall decrease when averaging across all drugs. But that aggregate masked what was actually happening: a small number of older, off-patent drugs fell sharply in price, pulling the average down, while thousands of brand-name drugs that patients actually depend on continued rising. Rx Savings Solutions, a drug cost consulting group, documented the real picture: 4,311 drugs raised prices in 2019, averaging a 21% increase. The 619 that fell in price brought the mathematical average down — but didn't help the diabetic whose insulin cost more, or the cancer patient whose treatment was 21% more expensive than the year before.
Throughout his first term, Trump repeatedly promised to lower drug prices and repeatedly failed to deliver. He promised to allow Medicare to negotiate drug prices — something that would require legislation and that every major pharmaceutical lobbying group opposed. He issued executive orders claiming to lower prices. Courts blocked the "most favored nation" rule that would have tied some US drug prices to lower international prices. His "American Patients First" blueprint, released in 2018, was long on goals and short on binding mechanisms. Drug companies raised prices anyway. By 2019, the United States was paying 2.5 times more for brand-name drugs than other high-income countries. That gap didn't close during Trump's first term.
In his second term, Trump revived the most-favored-nation executive order and issued new directives on drug pricing. The pharmaceutical industry lobbied aggressively against them. The practical impact on patients at the pharmacy counter remained limited. The structural problem — that the US government is prohibited by law from negotiating Medicare drug prices, and that pharmaceutical companies can price drugs at whatever the market bears — was not addressed by anything Trump signed in either term.
This post distinguishes between documented facts, allegations, and analysis. Where motive, intent, corruption, or illegality remains disputed in the public record, the text attributes that judgment to court findings, official records, direct quotes, or the reporting linked below.
- Trump SOTU claim — February 4, 2020; "first time in 51 years."
- PolitiFact — "Mostly False" rating; published February 5, 2020.
- Rx Savings Solutions data — 4,311 price hikes in 2019, avg 21%; 619 decreases; cited in PolitiFact and multiple news organizations.
- International drug price comparison — RAND Corporation 2021: US pays 2.56x more than peer nations for brand-name drugs.
- Most favored nation rule blocked — Federal court blocked rule December 2020; pharmaceutical industry lawsuit.