When Donald Trump walked back into the Oval Office on January 20, 2025, he didn’t wait around to start moving the furniture—and by furniture, I mean federal policy. One of the very first things he did was sign a massive executive order aimed at "Initial Rescissions of Harmful Executive Orders and Actions."
Deep inside that stack of papers was the end of Executive Order 14087.
You might not remember the number, but you’ve probably heard of the goal: "Lowering Prescription Drug Costs for Americans." It was a cornerstone of the Biden-Harris administration's strategy to expand on the Inflation Reduction Act (IRA). Honestly, the news cycle moves so fast that a lot of people missed what this actually meant for their medicine cabinet. Some folks thought the IRA was gone (it isn't), while others thought drug prices would spike overnight (it’s more complicated than that).
The $2 Copay That Vanished
Basically, the rescinded order had instructed the Department of Health and Human Services (HHS) to dream up new ways to make drugs cheaper using the Center for Medicare and Medicaid Innovation (CMMI).
One of the most talked-about ideas was the Medicare High-Value Drug List Model. This wasn't just some boring white paper; it was a concrete plan to cap copays at $2 for about 150 different generic drugs. We’re talking about medications for high blood pressure, high cholesterol, and diabetes—stuff millions of seniors take every single morning.
By rescinding the order, that $2 cap was effectively shelved.
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The administration argued these Biden-era models were "inflationary" or "illegal" overreach. But for a senior in Florida or Ohio who was looking forward to a predictable $2 bill at the pharmacy counter, the sudden reversal felt like a punch in the gut. Instead of that flat fee, many are now back to the "tier" system, where your costs can jump around depending on your specific Medicare Part D plan.
What about the Sickle Cell initiative?
Another big casualty was the Cell and Gene Therapy Access Model. This one was kinda technical but huge for families dealing with sickle cell disease. It was supposed to help state Medicaid programs pay for those multi-million-dollar "miracle" cures through outcomes-based deals. If the drug didn't work, the state wouldn't pay full price. When Trump rescinded the order, that framework hit a wall.
Trump’s "Most Favored Nation" Pivot
Now, don't think for a second that the administration just gave up on drug pricing. They just didn't like Biden's way of doing it.
By May 2025, Trump pivoted back to a favorite idea from his first term: the Most Favored Nation (MFN) pricing model. The logic is pretty straightforward, even if the math is a headache. He basically says, "Why is a guy in Berlin paying $50 for a pill that costs a grandma in Des Moines $500?"
His new 2025 Executive Order, "Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients," directs the government to try and match the lowest prices found in other wealthy, "comparably developed" countries.
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The pushback from the pharmaceutical industry was instant. Stephen Ubl, the CEO of the industry group PhRMA, has been pretty vocal, saying this kind of price-matching "jeopardizes hundreds of billions" in research and development. It's the classic tug-of-war: lower prices today vs. the cures of tomorrow.
The TrumpRx.gov Experiment
One of the weirder, more modern twists in this saga was the launch of TrumpRx.gov in late 2025. It’s essentially a government-run marketplace where manufacturers can sell certain high-cost drugs directly to you, the consumer.
The idea is to "cut out the middlemen"—the Pharmacy Benefit Managers (PBMs) that Trump often blames for high costs. It’s sort of like a government-backed version of Mark Cuban’s Cost Plus Drugs. By late 2025, the administration claimed they had deals with 14 major pharma companies to offer discounts through this portal, specifically targeting those popular (and wildly expensive) weight-loss shots like GLP-1s.
The IRA Is Still the Elephant in the Room
Despite all the rescinding and the new executive orders, the Inflation Reduction Act (IRA) is still the law of the land. Trump can't just "rescind" a law passed by Congress with a pen stroke.
That means:
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- The $2,000 Out-of-Pocket Cap: This is a biggie. As of 2025, if you’re on Medicare Part D, your out-of-pocket costs are capped at $2,000 a year. Trump’s actions didn't change this.
- Medicare Price Negotiations: The government is still negotiating prices for the most expensive drugs. However, the Trump administration has signaled they want to "improve" the process—which mostly means focusing on "transparency" and trying to fix the so-called "pill penalty."
- The Pill Penalty: Right now, the law allows the government to negotiate prices for "pills" sooner than "biologics" (injections). Pharma companies hate this. Trump’s team is looking to align these timelines, which might actually give drug companies more time before their prices get cut.
Why This Matters for Your Wallet
If you're trying to figure out what this means for your own bank account, you have to look past the headlines.
The rescission of the Biden order mostly stopped future experiments. It didn't necessarily raise the price of the drugs you bought yesterday, but it did kill off the "standardized" $2 copay that was supposed to start for generics.
The uncertainty is the real killer. When the government flips between "we're testing this model" and "we're rescinding that model," insurance companies get nervous. And when insurers get nervous, they tend to raise premiums just to cover their bases.
Actionable Insights: Navigating the New Landscape
So, where does that leave you? You can't control what happens in D.C., but you can control how you shop for meds.
- Check TrumpRx.gov: If you're on a high-cost medication, especially for weight loss or chronic conditions, see if your drug is listed. The "direct-to-consumer" model is the administration's flagship project right now.
- Don't Ignore the $2,000 Cap: If you've already spent $2,000 on prescriptions this year, your Part D plan should be covering 100% of your costs for the rest of the year. Make sure your pharmacy isn't accidentally charging you.
- Ask for the "Cash Price": Sometimes, even with all these government programs, the cash price at a place like Costco or through a discount card (like GoodRx) is cheaper than your insurance copay.
- Watch the "Pill Penalty" News: If you’re on a brand-name biologic, keep an eye on whether Congress changes the negotiation timelines. This could determine how soon a "Maximum Fair Price" kicks in for your specific medication.
The reality of drug pricing in 2026 is a messy mix of old laws and new executive whims. While the $2 generic dream might be on ice for now, the "Most Favored Nation" fight is just getting started. It's a high-stakes game of chicken between the White House and Big Pharma, and you're the one sitting in the middle with a pharmacy receipt in your hand.
To stay ahead of these changes, you should review your Medicare "Evidence of Coverage" document every October. Plans are required to update you on how these federal shifts affect your specific copays and deductibles for the coming year.