Trump Presses Pharma Chiefs With Ultimatum: “60 Days or Consequences”

White House Press Secretary Karoline Leavitt revealed Thursday that President Donald Trump has directed 17 strong‑worded letters to the leaders of major pharmaceutical companies, insisting they lower drug prices or face governmental action. The correspondence signals a renewed push by the administration to confront what it calls “abusive pricing practices” in the U.S. drug market.

During the briefing, Leavitt read passages from Trump’s letter to Eli Lilly CEO David Ricks. The president accused other nations of “global freeloading” on American innovation and warned that he would use “every tool in our arsenal” to force price cuts if pharmaceutical firms fail to comply.

“This unjust burden on American families ends with my administration,” Trump declared in the letter, which sets a 60‑day deadline for companies to respond or face punitive measures.

What Trump Wants

In the letters, Trump lays out explicit demands:

• Extend “most favored nation” pricing to Medicaid.

• Guarantee the same pricing terms for newly launched drugs.

• Redirect profits earned abroad back to American patients and taxpayers.

• Enable direct U.S. purchasing at the most favorable prices.

Leavitt emphasized that Trump expects good‑faith engagement from the CEOs immediately. The letters, made public via Truth Social, reflect mounting frustration from the administration over what it views as inadequate cooperation from pharma.

In May, Trump had already issued an executive order aimed at cutting prescription costs by 30% to 80%. That order tasked the Department of Health and Human Services (HHS) with establishing price targets within 30 days. But according to Trump’s letters, the proposals received during negotiation fell short—offering little more than “shifting blame” and requests for further policy changes that would benefit industry.

“Going forward,” Trump wrote, “the only acceptable outcome is one that gives American families immediate relief from runaway drug prices, and ends the free ride of American innovation by European and other developed nations.”

The Levers and the Limits

Trump’s earlier executive order laid out potential penalties for noncompliance:

• Directing HHS to write regulations to enforce cuts

• Expanding drug importation into the U.S.

• Reviewing and possibly restricting U.S. drug exports

• Empowering the FDA to alter or revoke drug approvals that fail standards of safety, efficacy, or marketing

Yet analysts say Trump lacks clear legal authority to unilaterally force pharmaceutical companies to adopt “most favored nation” pricing in foreign markets. Spencer Perlman, director of health care policy research at Veda Partners, notes the administration may push for a trial in Medicare or Medicaid using the CMS Innovation Center, but cautions that such moves would almost certainly spark legal challenges.

Essentially, Trump is counting on political pressure and public scrutiny to coax compliance from companies that aren’t legally compelled to yield.

“Right now he’s applying public pressure for voluntary action, which is all he can legally do in many cases,” a healthcare expert told CNN. “No company wants to become the next target of a federal government campaign—especially when enforcement authority is uncertain.”

Pharma Pushback and Innovation Concerns

Representatives from the pharmaceutical sector warn that unchecked demands could erode the incentives for innovation. Alex Schriver, senior vice president at PhRMA (Pharmaceutical Research and Manufacturers of America), argued that adopting foreign-style price controls would undercut U.S. leadership in biopharmaceutical research—especially critical as China seeks to compete in that arena.

“Importing price controls threatens both patients and industry,” Schriver said. He added that to truly address high prices, policymakers should aim at reducing costs from middlemen in the health care system and ensuring other countries pay their fair share for innovative medicines.

Critics of Trump’s approach also point out that because many of his demands lack statutory backbone, they risk being struck down in court. In other words, he is forcing companies to comply not via black-and-white law, but through political pressure and public accountability.

One analyst put it simply: “The president is trying to push companies to do what he doesn’t have the authority to force them to do.” That dynamic, some say, makes the letters more symbolic than legally binding—but still powerful in the arena of public opinion.

What’s Next

The next 60 days will be closely watched. The pharmaceutical CEOs have a decision to make: engage openly and offer meaningful concessions, or resist and risk being portrayed as obstacles to lifesaving medicines. Regardless, Trump has telegraphed that he intends to keep this fight at the center of his agenda—and that he sees public pressure as a formidable tool.

In the battle for drug pricing in America, the coming weeks may show whether political muscle can do what legislation has struggled to achieve: meaningful relief for patients burdened by soaring prescription costs.