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A year after Trump's Medicaid drug price pledge, program faces delays and uncertainty

NPR reports that a year after President Trump promised most-favored-nation drug prices for Medicaid, the voluntary pilot remains marked by delays and uncertainty over which drugs and states will participate.

Updated Sep 17, 2026 · 18:34 UTC1 reports

The short version

  • A year after President Trump pledged to lower Medicaid drug prices, the effort has been plagued by uncertainties, delays and a lack of transparency, according to NPR.[NPR]
  • The pilot relies on voluntary participation by drugmakers and states, and the administration has not released the pricing agreements, leaving unclear which drugs will be discounted.[NPR]
  • NPR contacted Pfizer and 16 other major drugmakers; none confirmed all their drugs would receive Medicaid discounts, and several said only selected products would be discounted.[NPR]
  • Medicaid covers 66 million Americans, and net prescription drug spending rose 46% between 2019 and 2024 to $46 billion, according to KFF.[NPR]

Key facts

  • On Sept. 30, 2025, President Trump said Pfizer would offer all its prescription medications to Medicaid at most-favored-nation prices and said he expected other manufacturers to follow.[NPR]
  • Medicaid covers 66 million Americans; net prescription-drug spending rose 46% between 2019 and 2024 to $46 billion, according to KFF.[NPR]
  • A year after the pledge, the effort has been marked by uncertainties, delays and a lack of transparency.[NPR]
  • The pilot relies on voluntary participation by both drug companies and states, potentially limiting the number of discounted drugs and patients reached.[NPR]
  • The administration has refused to release the pharmaceutical agreements, leaving unclear whether companies must offer most-favored-nation discounts for all their drugs.[NPR]
  • NPR reached out to Pfizer and 16 other major drug companies; none would confirm all their drugs would be discounted in Medicaid or specify which ones would be.[NPR]
  • Several companies said only selected products would be discounted, including Gilead for hepatitis C, hepatitis B and HIV; Sanofi for certain diabetes, cardiovascular, neurological and cancer medicines; and Eli Lilly for many medicines except its GLP-1 drugs.[NPR]
  • Experts warned companies have an incentive to cherry-pick products that already receive Medicaid's best discounts, producing negligible additional savings.[NPR]

What remains uncertain

  • The breadth of discounts and potential savings remains unclear because the agreements are unpublished.[NPR]
  • It is not known which drugs will be discounted, as none of the 17 manufacturers contacted by NPR confirmed all their drugs would receive Medicaid discounts.[NPR]
  • Experts warn manufacturers could cherry-pick drugs already heavily discounted for Medicaid, yielding negligible additional savings.[NPR]

Sources

Outlet counts describe coverage, not independent confirmation. Reports may share a wire service or original source.