Trump Administration Issues 60‑Day Ultimatum to Big Pharma: Slash Prices or Face Consequences

In a bold escalation of his fight against high drug costs, President Donald Trump’s administration has delivered a stark ultimatum to the pharmaceutical industry: lower prescription prices within 60 days—or be met with sweeping federal intervention.

Seventeen separate letters were sent directly to CEOs of the globe’s largest drug manufacturers, a dramatic move unveiled in a White House briefing by Press Secretary Karoline Leavitt. The letters made clear that the administration intends to use every available tool if the industry fails to act.

“If you refuse to step up, we’ll deploy every tool in our arsenal to protect American families from continued abusive drug pricing practices,” the letters warned.

This initiative represents perhaps the most audacious attempt yet by any U.S. administration to challenge pharmaceutical pricing power—suggesting Trump is determined to make prescription affordability a centerpiece of his second term.

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The MFN Demand: Match the World’s Best Price

Central to the ultimatum is Most‑Favored-Nation (MFN) pricing—the concept that Americans should never pay more for the same drug than patients in developed countries abroad.

Currently, U.S. consumers often pay two to three times the cost of the same medications sold in Europe or Canada. The administration contends that the disparity amounts to unfair internal subsidy: Americans footing the bill to offset foreign price caps.

Under the MFN proposal spelled out in the letters, these requirements would expand to:

• Medicaid beneficiaries: ensuring low-income patients receive the lowest global price

• New drugs: requiring initial U.S. launch pricing to align with the lowest international rate

• Profit clawbacks: compelling companies to recoup excessive foreign earnings to subsidize U.S. patients

• Direct purchase options: enabling Americans to bypass intermediaries and pay MFN rates directly

Trump framed the demand forcefully in one letter: “Global freeloading ends with this administration.”

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Industry Reaction: Alarm Bells and Strategic Delay

Quoting from the letters, markets briefly reeled—shares of Pfizer, Merck, and Johnson & Johnson all dipped. Analysts noted oiling fears that companies would fight the policy or carve out loopholes.

Pharma leaders have countered that punishing margins would suffocate innovation. “If U.S. pricing flexibility vanishes, so too may funding for future cures,” one executive warned on condition of anonymity.

Yet critics dispute that argument. They argue industry profits already run extraordinarily high, and that price shielding tactics have long been justified as necessary for R&D investment.

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Trump’s Track Record & Rising Pressure

Trump’s war on Big Pharma is not new. In his first term, he floated international reference pricing, transparency mandates, and measures to shift rebate flows—but many of those efforts were diluted or overturned.

This time, with a clear 60-day deadline, he is betting political momentum and public pressure will force the industry’s hand. Polls show overwhelming public support for drug price reforms across party lines, giving his team confidence in a bold push.

Trump has repeatedly framed the issue as one of fairness. “Other nations negotiate and get deals,” he has said. “We don’t—that ends now.”

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Why 60 Days? The Ticking Countdown

The 60-day timeframe is neither arbitrary nor symbolic—it is tactical. It places immediate pressure ahead of fall legislative work and gives little runway for extended negotiation or delay.

If drugmakers fail to comply, the administration hinted at several escalations:

• Regulatory action by HHS

• Government negotiation for Medicare or Medicaid purchasing

• Executive orders expanding direct pricing authority

• Trade or penalty measures against noncompliant firms

That said, industry groups are already preparing litigation. The crux of their expected arguments: MFN mandates breach constitutional protections and violate international trade norms.

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Political Tightrope: Gains vs. Risks

For Trump, success would be a powerful political win—real cost relief delivered to millions. But failure could erode credibility with a base that expects him to take on elite interests.

Democrats, who have long advocated for drug reform, now face a dilemma: support Trump’s strategy and give him credit, or push for deeper systemic change under a different banner.

Republicans are split as well. Populists back the challenge to corporate power; free-market conservatives worry about executive overreach and penalties bleeding innovation.

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Global Dominoes: Price Warfare Abroad

If the U.S. enforces MFN pricing, ripple effects may strain global markets. Drugmakers could respond by raising prices overseas to compensate, triggering tension with foreign governments used to negotiating hard.

Some analysts warn of a two-tier release system: companies might delay drug launches in countries unwilling to pay steep prices. Others see it as a shift in leverage—until now, the U.S. has borne much of the burden for global drug pricing.

Supporters argue the move simply levels the playing field: American patients deserve no less than the best deals secured abroad.

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The Bigger Battle: Beyond Drug Prices

Drug pricing is only one facet of America’s healthcare cost crisis. True reform will require tackling opaque rebate systems controlled by intermediaries (PBMs), patent extension loopholes, and barriers to competition in generics and biosimilars.

Trump’s team has signaled they may next pressure PBMs, calling out rebate arrangements as “secret profits” that fail to benefit patients.

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What’s Next in the 60-Day War

The next eight weeks will be decisive. Pharmaceuticals will mobilize lobbying and media campaigns. Consumer advocacy groups will press for transparent commitments. Legal challenges will mount.

Trump is clearly gearing up for a public showdown: “Lower your prices or we will do it for you,” he has said repeatedly.

The stakes are high. For pharma, the ultimatum is existential. For patients, it may be the relief they’ve awaited. And for federal power, it may define how far the government will go to regulate markets in the name of fairness.

Whether this all results in real reform or another failed standoff is likely to leave a lasting mark on the relationship between government, industry, and healthcare in America.