TrumpRx Does Not Ensure “the Lowest Prices in the Developed World”

A perusal of the new TrumpRx site begins with a premise many Americans would readily agree with: too often, we pay far more for medicines than people in other high-income countries.

In giant font, scrawled across the homepage, TrumpRx.gov declares that “America was being overcharged for medicine.” Past tense, ushering in a new dawn. Americans were paying substantially more than residents of any other country for “the same drugs, made in the same factories, at the same dosages.” “This is unacceptable,” it reads. It was unacceptable. Now we have TrumpRx.

The platform goes on to claim it has ensured “every American gets the lowest prices on prescription medications in the developed world.”

PharmacyChecker price comparisons suggest otherwise.

After analyzing prices for all 43 brand-name drugs listed on TrumpRx (as displayed in February 2026), PharmacyChecker found that TrumpRx does not consistently offer the lowest available prices in the developed world. In many cases, significantly lower-cost options already exist — either through 1) FDA-approved generics already available at U.S. pharmacies; or 2) brand-name medications available through online pharmacies accredited in PharmacyChecker’s International Pharmacy Verification Program (IPVP).

These findings do not negate that some TrumpRx listings may reflect meaningful price reductions for some cash-pay patients. However, they do demonstrate that the platform does not consistently deliver the lowest available prices for uninsured or underinsured Americans, flying in the face of the statement that – again, in huge letters – this is “the most impactful prescription price reset in the history of our country.” The claim is potentially misleading to a patient population already forced to choose between food, utilities, and healthcare. Such framing matters.

Let’s dive in.

1) U.S. Generic Coupon Pricing Frequently Undercuts TrumpRx Brand Listings

PharmacyChecker compared brand-name prices listed on TrumpRx with generic coupon pricing available at U.S. pharmacies using the PharmacyChecker.com drug price comparison tool. Across 43 medications analyzed:

• 20 of the 43 TrumpRx drugs have FDA-approved generic equivalents available in the United States
• For 18 drugs, generic coupon pricing was, on average, 58.46% lower than TrumpRx brand listings* 

*(Two drugs with generic equivalents were excluded from the average due to more favorable pricing observed outside of PharmacyChecker’s platform at the time of analysis. More on that below.)

The takeaway is straightforward: brand discounts promoted through TrumpRx frequently remain more expensive than already available generic options in the U.S.

The exceptions (and a reminder about coupon volatility)

There are a couple of exceptions PharmacyChecker observed, where TrumpRx or GoodRx appeared to have the best option for patients: 

• Cytomel 50mcg: The brand hypothyroidism drug was cheaper through the TrumpRx savings coupon – $14.10 – vs. its generic liothyronine, which is $18.21 with a discount coupon found through PharmacyChecker.com drug price comparisons. (As with all coupons, these can shift quickly.)
• Vfend oral suspension 40mg/mL: PharmacyChecker observed the brand to be $306.98 on TrumpRx – significantly cheaper than the $592 generic voriconazole oral suspension found on PharmacyChecker.com. GoodRx had advertised the exact same coupon price as TrumpRx ($306.98) when we checked pricing last week, but now there are generic coupons advertised as low as $168.30! GoodRx may be the best bet for voriconazole oral suspension at the time of this writing. If you’re wondering about Mark Cuban’s outfit, CostPlusDrugs.com doesn’t appear to carry the oral suspension formulation. 

PharmacyChecker has observed volatility across coupon platforms; patients should re-check multiple sources when refilling prescriptions.

Important nuance about generic availability (and why some patients still prefer brands)

I think it’s important to point out that there is a patient population that would still prefer the brand-name drug to any generic. FDA’s standard is that all “generic drugs approved by FDA have the same high quality, strength, purity, and stability as brand-name drugs.” 

A MedShadow survey shows that one-third of Americans say their generics don’t always work the same as the brand and two-thirds would be willing to pay more for medications, granted they were tested by an independent third party to ensure safety and effectiveness. 

Suzanne Robotti, founder of MedShadow, former FDA Advisory Committee on Drug Safety and Risk Management member, and patient advocate, is quoted in that same piece that while the intent of the FDA is that generics are equivalent to brands, “a small but significant amount of generic drugs are sub-quality, and that puts patients at risk.” 

There are documented cases in which patients report problems after switching from the brand to the generic. One widely cited example is, after hearing an echo of patients experiencing horrific side effects, Joe Graedon and People’s Pharmacy’s investigation into Wellbutrin XL (generic: bupropion XL), which revealed that the FDA had relied on bioequivalence studies of the 150 mg strength with extrapolation to 300 mg instead of testing the 300 mg directly, a decision that negatively affected unsuspecting patients.

Related and formative to my thinking on global drug safety, Katherine Eban’s book Bottle of Lies documents whistleblower-driven scrutiny of generic drug integrity and manufacturing practices in the United States’ reliance on foreign drug facilities for the manufacture of the majority of their generic (and brand name) drugs. 

All of this is not to say that “generics are bad” –  it’s context for why some patients may still seek the brand despite generic availability.

2) Brand-Name Drugs Still Cost Less Through Accredited International Pharmacies

TrumpRx is tied to broader U.S. policy efforts associated with “Most-Favored-Nation” (MFN) drug pricing, which aims to lower prescription prices by linking them to the lowest prices paid in comparable developed countries. 

But PharmacyChecker’s comparisons found that for a subset of TrumpRx-listed drugs, lower brand prices were available internationally through dispensing partners of PharmacyChecker-accredited online pharmacies. Across 43 medications analyzed:

• 19 brand-name drugs were available, on average, 50% lower through PharmacyChecker-accredited international pharmacies than the TrumpRx displayed brand prices.
• Lower prices appeared from dispensing locations including Canada, the UK, Australia, New Zealand, India, and Mauritius.

Under the Trump administration’s MFN approach, the benchmark is defined as the lowest price in OECD peer countries meeting a GDP-per-capita threshold of at least 60% of the U.S. level, which certainly includes Canada, Australia, New Zealand, and the United Kingdom.

Three brand drugs were cheaper with a U.S. pharmacy coupon downloaded on PharmacyChecker.com than the savings advertised on TrumpRx.gov: 

• Nicotrol was 50.5% cheaper through a coupon found on PharmacyChecker.com compared to TrumpRx.
• Weight management drug Zepbound was priced 20% cheaper on PharmacyChecker.com compared to TrumpRx.
• Ngenla discount coupon prices were just over 4% cheaper than TrumpRx’s “favored” pricing.

Three brand drugs 1) do not have generic availability in the United States, and 2) are more affordable if ordered from an international online pharmacy compared to the savings advertised on TrumpRx.gov: 

• Premarin Vaginal Cream, for the management of menopausal vaginal symptoms, is 73% more affordable from a Canadian online pharmacy rather than through TrumpRx.
• Estring, also prescribed for menopausal vaginal symptoms, is 51% cheaper from a UK-based dispensing pharmacy compared to TrumpRx’s price.
• Xeljanz, used to mitigate symptoms for various autoimmune conditions, is 40% cheaper at an Australian international dispensing pharmacy compared to TrumpRx.

3. Which brand savings are significant on TrumpRx? 

One might find it easy to wave off TrumpRx as irrelevant. The truth is, some patients, particularly those who are uninsured or underinsured, may benefit. They will adhere to their prescribed therapy for COPD, diabetes, HIV, asthma, weight management due to the access this site affords them.

It’s also important to be clear about what TrumpRx is (and isn’t). TrumpRx is not a pharmacy storefront; it typically provides coupons or routes patients to manufacturer programs. For example, drug pages display pricing as an “out-of-pocket price,” and (to their credit) advise insured patients to check their co-pay first.

The following brand prices displayed on TrumpRx appear to be competitive among direct-to-consumer, out-of-pocket, cash-pay pathways. They have no generic availability in the United States. We include how specific drugs’ TrumpRx savings can be redeemed, according to the website.

Bottom line: TrumpRx discounts are not the “lowest in the developed world”

Even when there are real discounts, the framing still matters. 

“Thanks to President Trump, the days of Big Pharma price-gouging are over”

Unfortunately, that’s hardly the case. Broader health policy research emphasizes that U.S. drug prices remain among the highest in the world. RAND estimated U.S. prescription drug prices are 278% of those in 33 other nations (and 422% for brand-name drugs). And policy wonks and makers continue to analyze various approaches, including MFN reform, and pull different levers, most recently Medicare’s newfound power to negotiate certain drug prices.

The systemic rot in U.S. drug pricing is complex and well-documented: patent games, such as evergreening, product hopping, and intentional thickets, all of which delay competition; limited generic and biosimilar uptake even after exclusivities expire; opaque rebate structures benefiting pharmacy benefit managers and other questionable middlemen; fragmented, profit-driven purchasing power; a lack of broader, more ambitious direct government negotiation. All of these forces shape – and bloat – the cost of drugs in this country.

In this context, a government-sponsored platform that 1) covers a limited list of drugs, 2) uses coupons/manufacturer program pathways (that do not meaningfully outcompete existing market options), and 3) does not directly set prices is perhaps not positioned to ensure that “every American gets the lowest prices on prescription medications in the developed world.”

To its credit, TrumpRx makes sure to add a word of cautionary advice about their prices on each drug page: “This is an out-of-pocket price. If you have insurance, check your co-pay first—it may be even lower.”

Indeed. 

When access to affordable medicine feels out of reach despite insurance coverage, patients and caregivers should:

• Ask a trusted clinician about lower-cost options (generics, dosage forms, therapeutic alternatives, samples, community pharmacies)
• Compare cash-pay discount prices across platforms (PharmacyChecker.com, TrumpRx.gov, GoodRx.com, CostPlusDrugs.com, etc.)
• If considering international order, use accredited and verified options.

Without more aggressive reform, transparency and comparison remain the most reliable tools for improving affordability for patients today.