The Trump administration is taking direct aim at pharmaceutical giants once again — this time with an explicit warning that if drug prices do not come down soon, the White House will use federal authority to force the issue.
White House Press Secretary Karoline Leavitt confirmed Thursday that President Donald Trump has sent letters to 17 pharmaceutical CEOs, urging immediate action to reduce medication costs and pledging to “deploy every tool” available to ensure compliance.
According to Leavitt, the letters make it clear that the president’s patience has run out with what he calls “abusive pricing practices” that have left American consumers paying more than citizens of any other developed nation.
“The president is demanding results — not promises, not delays,” Leavitt told reporters during a press briefing. “He has made it clear that if these companies do not act within 60 days, his administration will consider all legal and regulatory options, including the use of price controls.”
The Letter to Eli Lilly and Beyond
Leavitt read portions of one of the letters — addressed to Eli Lilly CEO David Ricks — in which Trump accused pharmaceutical executives of allowing foreign nations to “freeload” off the United States by charging higher prices domestically to offset discounts abroad.
“This unacceptable burden on American families ends with my administration,” Trump wrote. “For decades, our people have paid the highest drug prices in the world while other countries pay pennies on the dollar. Those days are over.”
The president referenced a spring executive order focused on drug affordability, which directed the Department of Health and Human Services (HHS) to negotiate fairer pricing and expand transparency requirements.
Key Demands Outlined in Trump’s Letters
The letters, which have since been posted publicly on Trump’s Truth Social account, outline several specific measures the White House expects pharmaceutical companies to adopt voluntarily:
Most-Favored-Nation Pricing:
Drug makers must extend their lowest global prices — known as “most favored nation” rates — to Medicaid and other U.S. public health programs.
Fair Pricing for New Drugs:
Newly launched medications must enter the U.S. market at a cost equal to or lower than what the same product sells for abroad.
Revenue Reinvestment:
Companies earning large profits from international markets must return a portion of those revenues to U.S. taxpayers and patients.
Direct Purchasing Reform:
The federal government should be allowed to purchase prescription drugs directly from manufacturers at the most favorable global rates.
Trump’s tone was characteristically forceful, warning that if drug makers refuse to comply, the administration “will act decisively to protect American families.”
“If you refuse to step up,” Trump wrote, “we will deploy every tool in our arsenal to protect the American people from the greed and indifference of an industry that has profited from their pain for far too long.”
Background: Executive Order on Drug Prices
In May 2025, President Trump signed an executive order aimed at reducing prescription drug prices by 30 to 80 percent. At the time, he called the measure one of the most aggressive consumer protection policies in decades.
The order required HHS to set target price reductions within 30 days and to open negotiations with major pharmaceutical firms. However, according to reports from CNN and other outlets, the ensuing talks produced “little progress” — a frustration Trump echoed in this week’s letters.
“Most of the proposals my administration has received,” Trump wrote, “offered nothing but excuses, policy loopholes, and requests for more subsidies. That’s not reform — that’s business as usual.”
Leavitt told reporters that the president expects “substantial engagement” from the pharmaceutical industry in the coming weeks but added that “the clock is ticking.”
Industry Reaction
So far, the pharmaceutical sector has responded cautiously. A spokesperson for PhRMA, the industry’s leading trade group, issued a brief statement Thursday emphasizing the companies’ “ongoing commitment” to affordability but warning that “heavy-handed government interference” could have unintended consequences.
“We share the administration’s goal of making medicines more affordable,” the statement read, “but price controls risk stifling innovation, delaying new treatments, and reducing patient access to breakthrough therapies.”
Privately, several executives have expressed concern about the possibility of sweeping federal intervention — particularly the idea of most-favored-nation pricing, which would effectively force American companies to match the lowest global price for each medication.
Economists note that such a policy could reshape the global pharmaceutical market, where U.S. consumers currently account for nearly half of all prescription drug spending worldwide.
Public Opinion and Political Context
Public support for drug price reform remains overwhelmingly strong. A Pew Research poll conducted earlier this year found that 83 percent of Americans — across political lines — believe prescription drugs cost too much.
The issue has become a cornerstone of Trump’s 2025 re-election platform, as the administration seeks to contrast its populist approach to corporate accountability with what it calls the Democrats’ “talk-without-results” stance.
“Democrats had eight years to fix this and did nothing,” Trump said in a recent Truth Social post. “We’re the ones who are actually standing up to Big Pharma.”
Critics argue that the president’s strategy could backfire if companies respond by pulling certain products or reducing research investments, but supporters counter that years of unchecked pricing justify drastic measures.
A Pattern of Confrontation
This is not the first time Trump has gone head-to-head with the pharmaceutical industry.
During his first term (2017–2021), he repeatedly criticized drug makers for what he called “global price gouging,” and he issued several executive orders aimed at import competition and transparency in prescription labeling.
His administration’s revived focus on price reform in 2025 represents an escalation — one that places the White House in direct confrontation with some of the world’s largest corporations.
“President Trump has made it clear that he’s not afraid of a fight,” Leavitt said. “Whether it’s Big Tech, Big Pharma, or foreign governments, if they’re exploiting American consumers, they’ll be held accountable.”
Potential Consequences
If pharmaceutical companies fail to comply with the administration’s demands within 60 days, officials say the White House is prepared to implement a combination of executive action, regulatory penalties, and emergency purchasing authority to impose price reductions.
Experts suggest that could include:
Capping prices on drugs purchased through federal programs like Medicare and Medicaid.
Allowing states to import lower-cost drugs from Canada.
Freezing approvals for certain new drugs until companies meet affordability benchmarks.
Such actions would almost certainly face legal challenges, but Leavitt indicated the president “is willing to take that risk.”
Looking Ahead
For now, the pharmaceutical industry faces a deadline — and growing public scrutiny.
Trump’s allies in Congress, including Sen. Josh Hawley (R-MO) and Rep. Marjorie Taylor Greene (R-GA), have already voiced support for the president’s push, calling it “a necessary step toward breaking the monopoly of pharmaceutical greed.”
Meanwhile, health policy analysts say the administration’s next moves could set a precedent for how far federal authority extends over private industry pricing.
“This is uncharted territory,” said Dr. Elaine Porter of the Brookings Institution. “If the administration follows through, it could fundamentally reshape the relationship between the government, the pharmaceutical industry, and consumers.”
As the 60-day clock begins to tick, both Wall Street and Washington are watching closely — waiting to see whether drug makers comply, negotiate, or resist a president who has made confrontation his signature style.