Pharma5: Coming Soon — Rx Price Relief?

A flurry of federal activity is set to reshape the prescription drug market in the United States in 2026.

Americans currently spend more for prescription medicines than any other developed country. A 2024 RAND study showed that compared to countries in the Organisation for Economic Co-operation and Development (OECD), the price of generic medications were 2.78 times as high, and branded medications were 3.22 times as high in the U.S. — and that’s even after adjusting for estimated domestic rebates.¹ The U.S. spends a higher and growing share of the total drug spend on new drugs compared to other countries.¹

The skyrocketing cost of prescription drugs continues to limit access and adherence for millions of Americans, but the best way to bring prices down is unclear. The Inflation Reduction Act (IRA) of 2022 paved the way for price reductions on some of the most expensive drugs, but the wider affordability crisis is driven by a foggy, fragmented system in which drug companies set prices, pharmacy benefit managers negotiate prices, and Americans are left in the crosshairs of medication they need at prices they can’t afford.

Are lower prices on the horizon? Time will tell. Here are five measures that may move the needle toward lower prices as 2026 unfolds:²

1. IRA Negotiation Rollout

The much-anticipated first round of the 2022 IRA-negotiated prices for 10 high-cost Medicare Part D drugs goes into effect in 2026. Drugs include Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and NovoLog. Negotiated prices for these drugs are a minimum of 38 percent off of the 2023 list price, representing real savings for Medicare and Medicaid beneficiaries. Estimated savings are $1.5 billion in patient out-of-pocket costs and $6 billion for the Medicare program.³

2. Most Favored Nation Pricing Deals

The Trump administration is pushing for “most-favored-nation” (MFN) pricing to align U.S. drug prices to those in other OECD countries. Issued in May 2025, an executive order aims to put an end to Americans paying a significantly higher cost for the same products.⁴ Focused on making U.S. prices commensurate with the lower prices paid in other comparable countries, President Trump has negotiated with several large drug manufacturers to lower prescription drug prices for Americans.

3. Tariffs on Imported Drugs

In September 2025, President Trump announced a 100 percent tariff on imported branded and patented pharmaceuticals — a move meant to drive innovation and increase domestic production of prescription drugs in the U.S., ultimately securing the supply chain and lowering costs for consumers.⁴ However, the tariff has been paused to pursue negotiations with pharmaceutical companies. Whether or not the steep tariff negotiating tactic to secure deals for most-favored-nation pricing with major pharmaceutical companies will work remains to be seen.

4. New Centers for Medicare and Medicaid Services (CMS) Payment Initiatives

CMS has several new payment initiative models in the works, including the Medicaid GENEROUS Model, the Medicare GUARD Model and the Medicare GLOBE Model:

• GENEROUS Model. A voluntary model, GENEROUS aims to ensure fair and reasonable drug prices for Medicaid through negotiations with drug manufacturers. Manufacturers will provide supplemental rebates to participating states for drugs included in the model to align Medicaid prices with what other countries pay. This launches in January 2026 and will run for five years.⁵
• GUARD Model. This is a proposed mandatory model that would assess rebates for some drugs payable under Medicare Part D if U.S. prices exceed those paid in comparable countries. This model will launch on Jan. 1, 2027, and will be tested over five years.⁶
• GLOBE Model. With a focus on drugs given in a clinical setting (such as cancer, arthritis or autoimmune therapies), this proposed mandatory model would assess a rebate for some drugs payable under Medicare Part B if the prices exceed those paid in comparable countries. This model will launch in October 2026 and will run for five years.⁷

5. Launch of TrumpRx

An effort to lower prescription drug costs for American families without sacrificing innovation, TrumpRx is a direct-to-consumer platform that aims to connect patients to the MFN prices, making essential medications more affordable for everyday Americans by cutting out costly third-party markups. Nine major pharmaceutical companies have already agreed to participate with significant discounts, and additional companies are expected to follow. TrumpRx is set to launch in early 2026.⁸