BIP Winter 2025

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The administration views this as a model for corporate responsibility.

Cuban’s Cost Plus Drugs, which is aimed at lower-cost generic drugs. The administration views this as a model for corporate responsibility and a signal to other manufacturers, who are also being pushed under threat of tariffs, to join similar agreements. For Pfizer, the agreement provides a three year grace period from those potential tariffs, coupled

this direct-from-manufacturer program will not apply — at least initially. For an average consumer with good coverage, their co-pay or co-insurance, determined by their insurance formulary and negotiated prices, may very well be lower than even a 50% discount off a high retail list price. As critics point out, a 50% discount on a drug that costs over $1,000 out-of-pocket is still unaffordable for most. Some experts speculate that new reimbursement models, such as drug-only health reimbursement arrangements (HRAs), could emerge if regulatory support follows. The initiative primarily offers a potential safety net for two specific groups: 1. The uninsured: Individuals without health insurance could realize significant savings compared to paying the full retail list price. 2. High-deductible/non formulary patients: Those with high deductibles or whose specific brand-name drug is not covered by their formulary might find the discounted direct to-consumer price to be their cheapest out-of-pocket option. What it means for clients For our clients, the announcement serves as a timely reminder that prescription drug pricing is complex and often disjointed from their insurance benefit structure. Key takeaways for clients: • Compare prices. When Trum pRx.gov launches in 2026, it will become another variable in the price comparison equation. Patients should always compare their insurance co-pay against the discounted cash price

on TrumpRx.gov (and other discount sites like Single Care, GoodRx or Cost Plus Drugs) before filling a prescription. • Insurance remains primary. For the insured, especially those who have met their deduct ible or have low co-pays, their insurance will likely remain the most cost-effective path for medicines covered by the plan. • There will be an impact on innovation and formularies. The long-term impact hinges on two major factors: whether other manufacturers partici pate, and how this new pricing dynamic interacts with PBM negotiations and insurance formularies. If MFN pricing genuinely lowers list prices, it could eventually lead to lower costs across the board, but this remains to be seen. The Trump administration also announced a manufacturer direct in vitro fertilization program to lower the cost of these procedures for families. In the meantime, we must continue to guide our clients by emphasizing comprehensive coverage and formulary awareness. TrumpRx.gov is an incremental step toward price transparency and potential cash-pay relief, but it is not the wholesale system transformation that will immediately reduce costs for most insured Americans. Hasday is president of the National Employee Benefits Practice at EPIC Brokers.

with a commitment to invest significantly in U.S. domestic manufacturing. The broker’s perspective The vast majority of Americans rely on private insurance, Medicare or Medicaid, and

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