First Term Record — 2017–2021 drug prices pharma broken promise fact-checked

Trump Promised to Negotiate Drug Prices. The Pharmaceutical Industry Lobbied. He Folded.

Trump said pharmaceutical companies were "getting away with murder." He promised to let Medicare negotiate drug prices directly — something that had been explicitly blocked by law since 2003. He met with pharmaceutical company CEOs in January 2017 and described a plan to cut prices dramatically. What followed over four years: several executive orders of limited scope, significant pharma lobbying, a series of proposals that were blocked, delayed, or watered down, and ultimately no change to the fundamental prohibition on Medicare drug price negotiation. The United States continues to pay 2-3x more for the same drugs than Canada, Germany, and other wealthy nations.

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"Pharma has a lot of lobbies, a lot of lobbyists, a lot of power. And there's very little bidding on drugs. We're the largest buyer of drugs in the world, and yet we don't bid properly."

— Donald Trump, January 11, 2017, nine days before his inauguration, at a press conference announcing a meeting with pharmaceutical executives
3xMore than Canadians pay for the same drugs, on average, in the US
$1,300Average annual spending on prescription drugs per American
$0Change to Medicare's ability to negotiate drug prices during Trump's first term
10First drugs whose prices Medicare can now negotiate under Biden's IRA — Trump admin working to undermine

The Medicare Modernization Act of 2003 — passed under George W. Bush — explicitly prohibited Medicare from negotiating drug prices with pharmaceutical manufacturers, requiring Medicare to pay whatever price manufacturers set. The explicit prohibition was a gift to the pharmaceutical industry worth billions annually. Trump promised to change this. He did not. His administration issued executive orders allowing importation of drugs from Canada under certain circumstances and requiring "most favored nation" pricing — paying no more than what other countries pay — but both were blocked, challenged, or delayed before taking effect.

Biden's Inflation Reduction Act of 2022 was the first law in US history to allow Medicare to directly negotiate the prices of certain prescription drugs. The first 10 drugs subject to negotiation were announced in 2023. The projected savings were in the tens of billions over a decade. Trump has called the IRA a "disaster" and his second-term administration has taken steps to slow or undermine the drug negotiation provisions — attempting to roll back the one concrete achievement on drug pricing that actually happened.

Verification note

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.

The Sources
  • Trump pharma "murder" quote — January 2017 press conference; archived by multiple outlets.
  • MMA 2003 noninterference provision — 42 USC 1395w-111(i); explicit prohibition on negotiation.
  • IRA drug negotiation — Inflation Reduction Act of 2022; first 10 drugs announced August 2023; CBO projected savings.
  • International drug price comparisons — RAND Corporation; Peterson-KFF Health System Tracker; 2-3x higher US prices documented.
  • Trump EO on most favored nation — September 2020; blocked by federal court.
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