TrumpDeclared Drug Pricing Victory. The Numbers Say Otherwise.
Trump cited a cholesterol drug cut from $537 to $225. Here's why experts say most Americans won't see anything similar.
Trump stood in the Rose Garden Thursday and announced the end of a yearlong campaign: Regeneron, the 17th and final holdout, had signed his Most Favored Nation drug pricing deal. "It should be front page news," he said. The White House fact sheet cited $27 billion in new U.S. investment, a cholesterol drug price cut from $537 to $225, and coverage of 86 percent of the branded drug market.
The ceremony was real. The victory may not be.
Every pharmaceutical company that signed an MFN deal before Regeneron — all 16 of them — also raised list prices on 872 brand-name drugs in the first two weeks of January 2026, according to an analysis by drug pricing research firm 46brooklyn. The median increase was 4 percent. Pfizer raised 72 products including a 15 percent hike on its COVID shot. Merck bumped up 18 drugs. The increases landed despite the fanfare surrounding those agreements, and in some cases before the ink was dry.
"Business as usual," said Antonio Ciaccia, CEO of 46brooklyn. "The deals probably are not very important in terms of manufacturer drug pricing and the prices paid by most Americans for prescription drugs," said Dr. Ben Rome, a health policy researcher at Brigham and Women's Hospital, who reviewed the agreements at Harvard's Program on Regulation.
The White House disputes the framing. Spokesperson Kush Desai said list prices aren't what matters — the specific Medicaid discounts and TrumpRx cash prices are. And it's true that most Americans don't pay list price; their insurance or government program negotiates something lower. But list prices are the starting point for those negotiations, and they set the ceiling. When list prices go up, eventually net prices follow.
The Regeneron deal itself may be the most expensive pharmaceutical agreement in U.S. history — though it's impossible to know for certain, because the terms are secret. The administration has refused to publish the contracts, saying they contain proprietary information and trade secrets. Democrats in Congress have pressed Health Secretary Robert F. Kennedy Jr. for details; his team has promised to release what it can without exposing confidential terms.
What is public: Regeneron committed to roughly $10 billion in U.S. manufacturing investment, according to an administration official. The company had already announced more than $7 billion in U.S. investments as of April 2025, including a more than $3 billion deal with Fujifilm Diosynth to double its domestic manufacturing capacity in North Carolina. The White House's $27 billion figure announced Thursday appears to include that prior commitment plus new spending — a distinction that matters when evaluating whether the deal produced fresh investment or simply repackaged existing plans.
The pricing provisions cover Medicaid and cash-paying patients using TrumpRx.gov — not Medicare, not employer-sponsored insurance, not the vast majority of Americans who get their coverage through commercial plans. Medicaid already pays the lowest prices of any payer. Critics note that advertising discounts on a government website is not the same as lowering what most patients actually spend at the pharmacy.
The deal was announced the same day Regeneron received FDA approval for Otarmeni, a gene therapy for a rare form of congenital deafness caused by mutations in the OTOF gene. The therapy — administered as a one-time injection into the inner ear — restored normal hearing in 42 percent of trial participants and improved hearing in 80 percent. The FDA approved it in 61 days, the fastest BLA review in modern agency history, under a program called the Commissioner's National Priority Voucher pilot. The program has no Congressional authorization. Democrats have raised concerns for months that the voucher pathway creates an incentive for companies to align with White House priorities in exchange for faster reviews.
Otarmeni will be provided free to clinically eligible U.S. patients — a genuine commitment, though one without a published cost estimate for manufacturing or delivery. The company will offer it at no charge, but the infrastructure to deliver a gene therapy to patients across the country, at scale, has never been tested.
Trump has asked Congress to codify the MFN deals into law. Without legislation, the agreements rest on executive authority, tariff threats, and the goodwill of companies that have already shown a pattern of raising prices despite signing. The January price increases suggest the deals may have locked in higher baselines rather than constraining future ones. Whether Regeneron represents the finish line or the most expensive footnote in that pattern is a question the White House contracts don't answer.
