Trump's Executive Order on Drug Prices Includes Both Good and Bad Ideas

By: Ranier Simons, ADAP Blog Guest Contributor

On April 15, 2025, President Donald J. Trump signed Executive Order 14273: Lowering Drug Prices by Once Again Putting Americans First (Exec. Order No. 14273, 2025). The executive order is meant to delineate actions the Administration will take as solutions to lower prescription drug prices for Americans. The executive order’s actions include changes to the Medicare Drug Price Negotiation Program, drug importation, and addressing the activity of Pharmaceutical Benefit Managers (PBMs). The various provisions of the order are to be enacted on staggered timetables of 60, 180, and 365 days from the issuance of the order. The specificity of the various provisions varies. Yet, it is prudent to examine the major themes.

Photo Source: AP Photo/Alex Brandon

The most detailed section of the executive order is Section Three: Improving upon the Inflation Reduction Act (Exec. Order No. 14273, 2025). This section addresses the Administration's perceived flaws in the Medicare Prescription Drug Negotiation Program (MPDNP). The President describes the MPDNP as too complex and expensive, feels it caused changes to the Medicare Part D program that were detrimental to seniors, and distorts innovation by creating a “pill penalty” between large and small molecule drugs.

The “pill penalty” concerns the period allowed before a small-molecule or large-molecule drug is eligible for price negotiation. The MDPNP law identifies high-cost prescription drugs, whether brand name or biological, without generic or biosimilar equivalents, as eligible for negotiation (Cubanski & Neuman, 2025). This effectively means that small-molecule drugs would be affected by Medicare negotiated prices 9 years following their FDA approval, in contrast to 13 years for biologics. Small-molecule drugs are synthetic drugs that are chemically synthesized, while biologics are extracted from living organisms. Small-molecule drugs are typically administered in pill form or non-sterile liquid (Pantheon, 2025). Most biologics are available in injectable or intravenously administered forms, have special requirements to maintain stability, and are more complex and much more expensive to produce than small-molecule drugs (Caris, 2025).

Photo Source: YouTube / Seniors 4 Better Care

The executive order aims to increase small-molecule drug eligibility for price control to match that of the biologic drugs. The sentiment is that the discrepancy is a disincentive for investment in developing lower-cost small-molecule drugs, which are cheaper and used by a larger population than biologics (Exec. Order No. 14273, 2025). Biologics are typically used to treat things such as rare diseases or cancer. The possible outcome is that Medicare spending could increase. If this change were applied to the drugs that have already been selected in the first and second rounds of Medicare negotiations, half of the chosen medications, which equate to total gross Medicare Part D spending of $61 billion out of $91 billion, would not have qualified (Cubanski & Neuman, 2025). Some stakeholders are concerned that the change would result in higher prices and premiums for Medicare Part D recipients. The executive order mentions that other actions would be taken to prevent adverse price increases without specificity.

Section Eight: Reevaluating the Role of Middlemen hints at addressing issues surrounding PBMs (Exec. Order No. 14273, 2025). The order instructs a multi-department investigation to create recommendations “…on how best to promote a more competitive, efficient, transparent, and resilient pharmaceutical value chain that delivers lower drug prices”. The White House fact sheet released in tandem with the executive order also explains that the order will address the influence of middlemen and promote open competition (White House, 2025). While PBM reform initiatives are occurring in multiple states, recent actions of the Administration do not support the expressed desire for PBM reform. 

The Federal Trade Commission (FTC) is actively involved in a lawsuit against the three largest PBMs concerning their activities that allowed them to take in millions in profits at the expense of patients regarding high-priced insulin drugs. The FTC has also released a second report highlighting how PBMs have grossly marked up and manipulated generic drugs. Yet, the President fired two FTC commissioners in March (Godoy, 2025). This resulted in the FTC’s general counsel issuing an administrative stay in the case since there are no Commissioners available to adjudicate the case. 

Photo Source: AIS Health

Additionally, newly released draft legislation created by the House Judiciary Committee, in essence, removes federal antitrust enforcement powers from the FTC and consolidates them under the DOJ (Fuchs & McCarthy, 2025). The DOJ prosecutes the law, while the FTC, as an administrative body, has functions such as writing rules, enforcing laws, and conducting market studies. The Administration's actions favor its desire to bring about deregulation, which is not in alignment with PBM reform. The theme of deregulation is evidenced in the carefully worded verbiage of Section Two of the executive order, which states, “It is the policy of the United States that Federal health care programs, intellectual property protections, and safety regulations are optimized to provide access to prescription drugs at lower costs to American patients and taxpayers” (Exec. Order No. 14273, 2025).

Another notable section of the executive order is Section Ten: Increasing Prescription Drug Importation to Lower Prices (Exec. Order No. 14273, 2025). This section, in part, states it “shall take steps to streamline and improve the Importation Program under section 804 of the Federal Food, Drug, and Cosmetic Act to make it easier for States to obtain approval without sacrificing safety or quality.” A breadth of data indicates that drug importation as a means to lower prescription drug costs is not a viable tool. 

The nature of the drug supply and the drug supply chain indicate that there is not enough of a drug supply to acquire medications from a country like Canada, which is frequently referenced as a source for cheaper medications. Most importantly, drug importation lends itself to infiltration by bad actors that can introduce counterfeit, improperly handled, and low-efficacy drugs into the supply chain. Dangerous counterfeit drugs already exist in the U.S. drug supply. Bulk importation is a flawed idea since it would source medications from other countries outside the U.S. safe drug tracking system, which are not subject to our strict regulations and oversight. Moreover, Canada has explicitly stated, "Health Canada does not assure that products being sold to U.S. citizens are safe, effective, and of high quality, and does not intend to do so in the future” (Partnership for Safe Medicines, 2022). Florida, the only state with an FDA-approved drug importation plan, has already spent $50 million on a warehouse and over $24 million on an importer (Galewitz, 2024). It has not imported any drugs or saved any money.

The aforementioned sections are just a few of the fourteen sections listed in the executive order. Those sections describe more direct actions, indicating actionable changes. The other sections can be characterized as promises to investigate concerns, with the desired output being reports explaining the solution. Indeed, the high price of drugs is a problem worthy of intervention. However, the implementation of much of the order is unclear, as are the end products of what it nebulously implies. Time will indicate if the executive order results in benefits, falls short with no effect, or worse yet, creates more problems.

[1] Caris Life Sciences. (2025). Difference Between Small Molecule and Large Molecule Drugs. Retrieved from https://www.carislifesciences.com/difference-between-small-molecule-and-large-molecule-drugs/  

[2] Cubanski, J, Neuman, T. (2025, April 16). The Effect of Delaying the Selection of Small Molecule Drugs for Medicare Drug Price Negotiation. Retrieved from https://www.kff.org/policy-watch/the-effect-of-delaying-the-selection-of-small-molecule-drugs-for-medicare-drug-price-negotiation/

[3] Exec. Order No. 14273, F.R. 90 (2025, April 15). Lowering Drug Prices by Once Again Putting Americans First. Retrieved from https://www.federalregister.gov/documents/2025/04/18/2025-06837/lowering-drug-prices-by-once-again-putting-americans-first

[4] Fuchs, H., McCarthy, M. (2025, April 29). Trump could gain vast new deregulatory and antitrust powers under GOP megabill plans. Retrieved from https://www.politico.com/news/2025/04/29/trump-executive-powers-reins-act-ftc-antitrust-00317105

[5] Galewitz, P. (2024, November 20). Florida Gov. DeSantis' Canadian drug import plan goes nowhere after FDA approval. Retrieved from https://www.cbsnews.com/news/florida-desantis-fda-canadian-drug-imports/

[6] Godoy, J. (2025, March 19). Trump fires both Democratic commissioners at FTC. Retrieved from https://www.reuters.com/world/us/trump-fires-both-democratic-commissioners-ftc-sources-say-2025-03-18/

[7] The Partnership for Safe Medicines. (2022). Drug importation endangers U.S. patients. Retrieved from https://www.safemedicines.org/importation-page

[8] The White House. (2025, April 15). Fact Sheet: President Donald J. Trump Announces Actions to Lower Prescription Drug Prices. Retrieved from https://www.whitehouse.gov/fact-sheets/2025/04/fact-sheet-president-donald-j-trump-announces-actions-to-lower-prescription-drug-prices/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.