Let’s be honest—most presidential press conferences don’t get pharmacy owners’ hearts racing. But this one? This one… announcing the Trump Executive Order on prescription drug pricing, dropped some jaws.
President Trump’s latest executive order on prescription drug pricing may have just cracked the door open for the biggest shakeup we’ve seen in decades. From cutting out the middlemen to global price matching, it’s bold, controversial, and worth your full attention (here’s the official executive order for you to check out).
If you missed it—or just want to skip the political noise—here’s what matters, what’s promised, and what could actually impact your pharmacy.
The Flashy Trump Executive Order Headline: “Most-Favored-Nation” Pricing
The biggest headline? U.S. patients will no longer be stuck paying the highest prices in the world for medications. Under the executive order, select prescription drugs will be priced at the lowest rate available in any developed nation.
That means if Australia negotiates a better deal on a brand-name injectable, we get that price too.
Now, it’s not a done deal yet. The Secretary of Health and Human Services has 30 days to communicate pricing targets to manufacturers. If they don’t play ball voluntarily? The government has a few cards up its sleeve:
- Proposing MFN pricing regulations
- Authorizing the safe importation of cheaper drugs
- Launching antitrust investigations
- Reviewing and possibly revoking unsafe drug approvals
You don’t issue a threat like that unless you’re ready to follow through—or at least make a lot of noise trying.
Finally, Someone Said It: “Eliminate the Middlemen”
And not just someone… a sitting President of the United States. It is what gave me the chills. One of the most quoted moments of the press conference came when Trump said:
“We’re going to cut out the famous middlemen. Nobody knows who they are, but they’re rich.”
If that doesn’t make pharmacy owners sit up and cheer, I don’t know what will.
While the executive order doesn’t directly target pharmacy benefit managers (PBMs) and drug wholesalers—those layers in the system that seem to exist solely to extract value without providing care or producing products—it most definitely puts them in a precarious position. Forcing MFN pricing takes away PBM’s power. While it may not be how many pharmacy owners would approach the PBM problem, it does significantly weaken them.
Now, Let’s Talk Practical Pharmacy Impact From Trump Executive Order
We dug through the policy language and economic implications. Here’s how all this could ripple through your independent pharmacy:
1. PBM Disruption & Supply Chain Payment Upheaval
If PBMs lower prices before pharmacy companies and wholesalers do, the system explodes. If pharma lowers prices with a ton of existing inventory in the supply chain, the system explodes. If pharmacies can’t access the medication needed for patients, the system explodes. There is a lot to be excited about and a lot that can go wrong here.
2. Downward Pressure from Manufacturers
To align with MFN pricing, manufacturers may slash U.S. list prices. While that sounds amazing for both patients, pharmacies, and payers alike, it leaves a lot of questions. What happens to old inventory that was put into the supply chain at old prices? What about the pay-to-play formulary games that go on?
3. Drug Importation Gets a Green Light
For years, importing affordable drugs from Canada or Europe was a political football. This EO directs federal agencies to certify and facilitate safe, legal imports. If this expands to include pharmacies (and not just wholesalers or states), it could open doors to sourcing lower-cost medications, especially for brand-name medications.
4. Medicare, Medicaid, & 340B Pricing Shifts
Brace yourself. Government programs, particularly Medicare Part B and D, will likely realign their pricing using global reference points. That could drive down reimbursements for branded meds, even if the acquisition cost remains high. The cash cow for covered entities, which is 340B, just took a HUGE hit. While I don’t think it will go away, the margins are made in the spread pricing, and the spread pricing is finally getting squeezed hard with this Trump Executive Order.
5. Opportunities in Cash Pricing & DTC Partnerships
Here’s a potential win: If DTC channels become viable, your pharmacy could partner directly with manufacturers to offer competitive cash prices. That means bypassing insurance completely and selling at globally benchmarked rates. For savvy pharmacy owners, this could unlock new revenue streams and simplify transactions.
What This Means for You (At Least for Now)
Overall, I think the Trump Executive Order is a huge win and a reason to have hope. Does it solve all our problems? No. Is the Trump Executive Order a law? No. It is definitely a shift in our industry and a HUGE blow to our enemies.
It is a loss for them and a win for us.
This executive order doesn’t flip a switch overnight, but it sends a message that reform is on the table. The rhetoric was bold, the timeline aggressive, and the targets (PBMs, Big Pharma, foreign pricing games) couldn’t be clearer.
But one thing is certain: The landscape is shifting. You can choose to ride the wave or risk getting caught flat-footed. Now is the time to use this momentum to reach out to your senators and state legislatures, and help keep the momentum up to get more impactful wins.
Now let me get personal for a moment.
I haven’t been involved in the politics side of pharmacy for a long time. I got burned early on, and it’s been hard to focus any efforts in that bucket. Monday morning’s press conference did something that I didn’t think was possible: it gave me hope that real, positive, political change might actually be possible.
There were several moments where I got full-on goosebumps, especially when Trump said, “eliminate the middlemen.” To hear those words come out of a sitting president’s mouth? That 100% gave me hope.
Hope that someone, somewhere, with real authority is finally listening. It might not be the exact approach I’d take if I had the power, but for the first time in a long time, I’m actually hopeful that good change could be coming to our industry.
As good as this made me feel and gave me hope, it isn’t instantly changing our industry. You won’t be able to pay your bills with hope. You need to optimize and maximize every profitable angle that you can.
Now the question is: How well are you maximizing your profits right now?
If you’re ready to take control of what you can do right now and position your pharmacy to take advantage of this shift, join us inside Pharmacy Badass University. It’s the fastest way to optimize your business, increase profitability, and prepare for whatever comes next.
While the government sorts itself out, we’ll be over here building stronger, smarter, more independent pharmacies every day.
👉 Learn more at membership.diversifyrx.com
Stay informed. Stay flexible. And as always—stay badass.
