Donald Trump has introduced a series of initiatives aimed at reducing the cost of prescription drugs for Americans, though the situation is more nuanced than it appears.

This week, the White House celebrated its 17th voluntary agreement with a pharmaceutical company under Trump’s “most favored nation” (MFN) strategy.

The goal of this policy is to align U.S. drug prices more closely with the lower costs seen in countries like the UK, Canada, and Germany, where governments actively negotiate drug prices with manufacturers.

Trump contends that Americans have been overpaying for their medications compared to other countries that pay significantly less for identical treatments.

To address this, he has pushed major pharmaceutical companies to agree to deals that reduce prices on specific drugs, provide discounts directly to patients, lower Medicaid expenses, or impose caps on the costs of popular medications.

These agreements have already resulted in lower prices for cholesterol-lowering statins, used by millions of Americans, and weight-loss injections, which can cost patients up to $1,000 a month.

But critics say the scheme has major limits.

Many discounts only apply to uninsured patients or people whose insurance does not cover a drug. 

Donald Trump has unveiled a string of drug pricing deals he says will slash the cost of prescription medicines for Americans – but the reality is more complicated

Others relate to state Medicaid programs rather than ordinary privately insured families. 

And only a relatively small number of medicines have so far appeared on the TrumpRx website – the administration’s online portal for discounted prescriptions – meaning the scheme currently covers only a fraction of the thousands of drugs used by Americans. 

Still, the agreements do include lower prices for some high-profile medicines used for heart disease, diabetes, obesity, arthritis, asthma and cancer.

This week’s newest deal was with Regeneron, which agreed to cut the listed price of cholesterol-lowering drug Praluent from $537 to $225 via TrumpRx. 

It also pledged $27 billion in US investment and said it would provide a rare deafness gene therapy free to eligible patients.

Trump has described the agreements as historic and claimed some prices have fallen by as much as 600 percent – a figure widely disputed by economists and lawmakers.

Drug prices remain one of the most politically potent issues in America.

Millions of voters complain that medicines cost far more in the US than overseas, particularly insulin, inhalers, cancer drugs and newer weight-loss injections.

With healthcare costs rising, taking on ‘Big Pharma’ allows Trump to present himself as fighting for consumers while also pushing companies to manufacture more drugs in America.

Several agreements also include promises to invest billions in US factories and research.

Pfizer, one of the first companies to sign up, agreed to cut prices on a range of major medicines by between 50 and 85 percent, including statin Lipitor, nerve pain drug Lyrica and Covid treatment Paxlovid.

Eli Lilly struck a politically sensitive obesity deal, capping the monthly cost of its weight-loss injection Zepbound at $50 for some Medicare patients. 

Through its LillyDirect platform, some self-pay patients can also access lower prices than standard US retail costs.

Novo Nordisk, maker of Wegovy and Ozempic, agreed to pilot lower prices for semaglutide-based drugs for some Medicare and Medicaid patients – significant because those medicines have become symbols of America’s runaway drug costs.

Bristol Myers Squibb said it would provide blood thinner Eliquis free to Medicaid patients, while also discounting other medicines for cash-paying customers. 

Eliquis is one of the most prescribed drugs in America.

Amgen said it would offer migraine injection Aimovig and autoimmune drug Amjevita for a flat $299 a month – a substantial reduction on normal sticker prices.

AbbVie agreed to include arthritis blockbuster Humira and thyroid drug Synthroid in the programme, while also pledging $100 billion in US manufacturing and research spending.

AstraZeneca committed to selling chronic disease medicines direct to patients at around 80 percent off list prices, while GSK said it would lower costs on inhalers and respiratory drugs used for asthma and COPD.

Merck also joined the scheme, offering diabetes drugs Januvia and Janumet at discounts of up to 70 percent.