It's one of those questions that usually ends in a shouting match at the dinner table. If you ask ten different people whether prescription drug prices went up or down during the Trump years—and now into his second term in 2026—you’ll get ten different answers. Some swear he took a sledgehammer to Big Pharma’s profits. Others point to their own receipts at the pharmacy counter and say the numbers just keep climbing.
The reality? It’s messy.
Honestly, drug pricing in the U.S. is a labyrinth of rebates, list prices, "middlemen," and political theater. To figure out what actually happened, we have to look past the campaign rallies and dig into the actual data from the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS).
The List Price vs. Out-of-Pocket Tug-of-War
When people ask "did Trump increase the cost of prescription drugs," they’re usually looking at one of two things: the "sticker price" (list price) set by the manufacturer, or the amount they actually pay at the CVS register.
During Trump’s first term (2017-2021), the data showed a bit of a split. For the first time in nearly half a century, the Consumer Price Index for prescription drugs actually dipped slightly in 2018. It was a big talking point. Trump frequently mentioned that he was the first president in decades to see prices move backward.
But—and there is always a "but"—while the growth rate of prices slowed down, the list prices for many brand-name drugs kept ticking upward. According to ASPE reports, between 2017 and 2023, thousands of drugs saw price increases that outpaced inflation.
Basically, the "sticker price" didn't stop going up, but the administration used a lot of "bully pulpit" pressure to keep those hikes smaller than they had been under previous administrations.
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The 2026 "TrumpRx" and Most-Favored-Nation Pivot
Fast forward to right now, January 2026. The landscape has shifted dramatically because of the "Most-Favored-Nation" (MFN) model.
Trump’s recent executive actions have fundamentally changed the goalposts. The idea is simple: why should an American pay $1,000 for a drug that costs $200 in Germany? In late 2025, the administration struck deals with nine major pharma players—including giants like Bristol Myers Squibb, Merck, and Sanofi—to bring U.S. prices in line with the lowest prices paid by other developed countries.
Check out some of these 2026 price drops for people buying directly through the new TrumpRx.gov portal:
- Repatha (Cholesterol): Fell from $573 to $239.
- Januvia (Diabetes): Dropped from $330 to $100.
- Plavix (Blood Thinner): Sanofi slashed it from $756 down to just $16.
- Insulin: Sanofi committed to a $35 monthly cap on TrumpRx.
It’s a massive win if you’re paying cash. But if you’re using private insurance, you might not see these prices yet. That’s because these "deals" are often voluntary or tied to specific platforms, creating a two-tiered system where the "uninsured" price might actually be lower than the "insured" co-pay in some cases.
The Insulin Battle: Trump vs. Biden Claims
You've probably heard both Trump and Biden take credit for the $35 insulin cap. Who's telling the truth?
In 2020, Trump launched the Part D Senior Savings Model. It was a voluntary program. Medicare Part D plans could choose to offer insulin for $35, and about 800,000 seniors benefited.
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Then came the Biden administration’s Inflation Reduction Act (IRA). This made the $35 cap mandatory for everyone on Medicare, covering about 3.3 million people.
Now, in 2026, Trump has doubled down on his approach by pushing the Great Healthcare Plan. This plan aims to codify those $35 caps and expand them beyond just Medicare. It's a game of leapfrog where each administration tries to outdo the other’s "savings" numbers.
What Most People Get Wrong About PBMs
If you want to know why your meds are still expensive, you have to talk about Pharmacy Benefit Managers, or PBMs. These are the guys in the middle—the "brokers" who negotiate between drug makers and insurance companies.
Trump has been pretty vocal about "ending the kickbacks" paid by PBMs. The argument is that PBMs demand huge rebates from drug companies, which forces the drug companies to keep their "list prices" high so they can afford the rebate.
"In case after case, our citizens pay massively higher prices than other nations pay for the same exact pill... effectively subsidizing socialism abroad." — Donald Trump, 2025.
The 2026 policy focus is on Price Transparency. The administration is ramping up enforcement against hospitals and insurers that hide their "real" prices. The goal is to let you shop around. If the pharmacy across the street has the same pill for $20 less because they don't use a specific PBM, you should know that.
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The 2026 Reality Check: Are Costs Actually Lower?
Despite the big "wins" and the TrumpRx deals, the start of 2026 hasn't been all sunshine. Data from research firm 46brooklyn shows that in the first two weeks of January 2026, prices for 872 drugs still went up.
The median increase was around 4%. That’s not a "skyrocketing" increase, but it shows that the "cat and mouse" game between the White House and Big Pharma is far from over. Drugmakers are "recalibrating." When the government forces a price drop on a blockbuster drug like Ozempic, companies often raise prices on five other smaller drugs to make up the lost revenue.
The Nuance: Who Actually Benefits?
Whether Trump "increased" or "decreased" costs depends entirely on who you are:
- Seniors on Medicare: Generally seeing lower costs due to the cumulative effect of the $35 insulin cap and the 2026 implementation of negotiated prices for top-tier drugs.
- Uninsured/Cash Payers: Seeing big wins through TrumpRx.gov and MFN pricing deals.
- People with Employer Insurance: This is the gray area. If your employer’s plan has a high deductible or a "bad" PBM deal, you might still feel like you’re getting fleeced.
- Medicaid Patients: Benefitting from new CMS models (like the GENEROUS model) that tie Medicaid prices to international benchmarks.
Actionable Insights for 2026
If you're staring at a high bill for your meds, don't just pay it and grumble. The landscape is changing fast.
- Check TrumpRx.gov: If you have a high deductible, the cash price on this new federal portal might be lower than your insurance co-pay.
- Ask for the "International Benchmark": Many pharmacists now have access to "MFN-style" pricing or manufacturer coupons that align with the 2026 deals.
- Look at "Biosimilars": The FDA has been fast-tracking generic versions of "biologic" drugs (expensive shots). Always ask your doctor if a biosimilar is available.
- Monitor the Great Healthcare Plan: This is currently moving through Congress. If passed, it would codify many of these "voluntary" price drops into law, making them permanent regardless of who is in the White House.
The bottom line? Trump didn't "increase" drug costs in a vacuum, but he didn't end the upward trend of list prices either. He has focused on bypasses—creating new ways for you to get the "foreign" price without waiting for the whole system to fix itself. Whether that's a permanent fix or a temporary band-aid is the $600 billion question.
Keep an eye on the Medicare BALANCE model for obesity drugs like Ozempic and Wegovy. Those prices are set to fall to $245 for Medicare users this year—a far cry from the $1,000+ people were paying just a year or two ago.