OPINION:
For the past six months, Big Pharma has told consumers that agreements with the Trump administration will lower drug prices. It’s a nice change from decades of being told that the price of being American is paying three times what other developed countries pay for medications.
What Big Pharma claimed was not true. It was a slap in the face to see each of the 16 major drug companies that signed those deals raise the prices of their products at the start of 2026.
Here’s the elephant in the room: Big Pharma doesn’t need an agreement to lower prices. If drug companies discovered prices were economically unsustainable, then they would reduce them immediately.
In the world’s largest pharmaceutical market, prices remain persistently high, and we must ask the politically loaded and uncomfortable question: Why were Americans paying so much in the first place? That leads to a second uncomfortable question: Will the agreements actually matter?
Even the agreements have huge hurdles to overcome before they will lower prices for everyday Americans at the pharmacy counter. A likely critical component in lowering costs for Americans is requiring other developed nations to commit to raising their prices on medicines.
The Trump administration recently came to an agreement with Britain to increase its spending on medicines by 25%. The high margins on medicines in the United States disproportionately fund biotech research and development and innovation from which other developed nations benefit.
If prices in the U.S. are to be capped, then other nations will need to pay more to offset the loss of R&D funding here.
Once other countries adopt their appropriate pricing (a long shot if there ever was one), there’s the U.S. government’s poor history of producing health care websites that actually work. The last time Washington launched a major health care website (Healthcare.gov), it famously collapsed under even modest demand.
Even if everything goes right on the government side, there’s the simple fact that much of the effort to lower drug prices appears aimed at generics and high-profile legacy products. The ones crushing family budgets today are often specialty drugs, biologics, branded therapies, complex injectables and the cutting-edge cancer and autoimmune treatments.
These treatments account for more than 80% of the pharmaceutical market, and most can’t be solved with a one-size-fits-all approach.
What this means is that at the end of the day, patients won’t be the primary beneficiaries of any government agreements. In practice, government-backed pricing and distribution programs tend to boost the largest incumbents, concentrate market share, raise barriers to entry, squeeze out smaller competitors and lock in a cartel-like structure under “public-private partnership” branding.
Washington also has a habit of shifting costs rather than removing them. The administration said the 2026 list prices “aren’t important” because discounts “are coming to state Medicaid programs and patients who want to pay cash for some prescriptions.” New portals, new compliance requirements, new partnerships, new enforcement — none of this is free.
When programs expand, the debt expands with them. If the biggest pharma companies gain market share through government-backed promotion, then the public ends up paying twice: once at the pharmacy counter and again through taxes and debt. Sometimes, we’re finding out that the drug prices don’t even fall on paper.
President Trump is doing what presidents do: negotiating, applying pressure and pushing for results. The problem isn’t that the White House is trying. The problem is a structural environment in which the pharmaceutical industry has mastered a specific Washington strategy: maintain regulatory proximity and limit competition.
Combine this with a strong public relations narrative that promises future relief, deliver slow, partial and sometimes no change, keep the current system intact, and use the deal as proof they’re the good guys.
It’s the perfect arrangement. The public gets a headline to feel good about while nothing changes — especially the narrative that to be American is to pay exorbitant prices.
If we want drug prices to fall, then there’s something else Washington can do, and it’s the stuff Big Pharma fears most: easier entry for competitors, faster approval pathways, less protectionism, fewer artificial barriers, fewer sweetheart arrangements, more transparency and real consumer choice.
In other words, a freer market. Because the only force that reliably drives down prices over time is not a deal. It’s competition.
• Mike Feuz is an economist with a master’s degree in economics from George Mason University.
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