The Trump administration officially launched TrumpRx to help patients access more affordable drugs. It's getting a lot of press—as all of President Trump's actions do—but it feels like noise. The model itself isn’t that innovative. Current direct-to-consumer pharmaceutical discounts from GoodRx, Cost Plus Drugs, and pharmaceutical companies themselves, are already doing what TrumpRx accomplishes. From what I can tell, TrumpRx appears to be a GoodRx wrapper.
In this article, I'll provide quick background on the drug pricing issue in the U.S., dive into what we know about TrumpRx, and explain how this will impact patients, physicians, and the health system.
Before beginning, I just want to plug my prior Drug Supply Chain content and my Healthcare 101 course, in which I teach you about the drug supply chain and the interworking of this messy healthcare system. Worth it!
Drug Supply Chain 101
The drug supply chain is an incredibly complex system involving multiple stakeholders, with money flowing in all directions and medications passing in a linear fashion from drugmaker to patient. Below is a flow chart I’ve made of the money flow and drug flow.
The drug supply chain consists of several interconnected entities, each with specific responsibilities that contribute to the overall process. The key stakeholders include:
Drug Manufacturers: These are the companies that develop, produce, and market medications. They are responsible for the research and development of new drugs, ensuring that they meet regulatory standards before entering the market. Once a drug is approved, manufacturers produce it in large quantities and sell it to wholesalers.
Wholesalers: Wholesalers act as intermediaries between drug manufacturers and pharmacies. They purchase drugs in bulk from manufacturers and distribute them to various pharmacies, hospitals, and other healthcare providers. Wholesalers play a crucial role in ensuring that medications are available where and when they are needed.
Pharmacies: Pharmacies are the final step before a medication reaches the consumer. They purchase drugs from wholesalers and dispense them to patients according to prescriptions provided by physicians.
Third-Party Pharmacy Benefit Managers (PBMs): PBMs are middlemen that manage prescription drug benefits on behalf of health plans. They negotiate prices with drug manufacturers, manage formularies (lists of covered drugs), and process prescription drug claims. PBMs play a significant role in determining the cost of medications for consumers by negotiating rebates with manufacturers.
Health Plans: Health plans are organizations that provide insurance coverage for prescription drugs. They work closely with PBMs to determine which drugs are covered and how much consumers will pay out-of-pocket. Health plans often receive rebates from PBMs, which can affect the overall cost of drugs for both the plan and the consumer.
Consumers: Consumers are the end-users of medications. They interact directly with pharmacies to obtain their prescriptions, and their out-of-pocket costs are influenced by the prices negotiated by PBMs and health plans.
U.S. drug affordability is complicated by market exclusivity, patent protections, and healthcare system structure (see the PBMs and rebates)—issues I've covered here. Pharmaceutical companies maintain pricing power through extended exclusivity periods and patents that block competition. While these incentives encourage innovation, they often produce unaffordable prices for patients and strain the healthcare system. Fragmented insurer negotiations and absent unified government regulation worsen the problem, leaving consumers bearing the cost.
The simplest solutions to lower drug prices are either working with the middlemen or removing the middlemen that profit off the complexity of the drug supply chain.
Three key examples of companies doing this:
GoodRx (playing with the middlemen): Patients access lower prescription prices via coupons without using insurance. GoodRx partners with major PBMs like CVS Caremark and OptumRx. When a patient searches for their medication on GoodRx, they see discounted prices at local pharmacies—prices negotiated between the PBM and pharmacy, not the cash prices pharmacies typically charge. Say a patient needs pantoprazole. Their insurance copay is $20, but GoodRx shows a $10 price at CVS. The patient downloads the coupon, presents it at the pharmacy, and pays $10 instead, avoiding the copay of $20. But the prescription isn't actually “cash pay”—it’s processed through a PBM like an insurance claim, but not necessarily the PBM the patient’s insurer uses. When the patient uses the GoodRx coupon, the pharmacy pays a transaction fee to the PBM. The PBM then shares part of that fee with GoodRx. That's GoodRx's revenue: a cut of the transaction fee on every prescription filled with their coupon. Patients and PBMs win in this model, and pharmacies lose (which is why many don't like GoodRx).
Cost Plus Drugs (getting rid of the middlemen): Mark Cuban's direct-to-consumer online pharmacy lowers the cost of generic medications by simplifying the drug supply chain. For the most part, Cost Plus Drugs eliminates middlemen and operates on a cash-only basis. It uses transparent pricing: manufacturing cost + 15% markup + $3 pharmacy labor fee + $5 shipping. The company has also begun partnering with health systems.
Pharma Direct to Consumer (getting rid of and playing with the middlemen): Pharmaceutical companies are building telehealth and direct-cash models to make their medications (like Wegovy) more accessible and affordable for patients. In the telehealth model, pharmaceutical companies partner with a telehealth company (middleman). The pharmaceutical company refers patients needing access to their medication (e.g., GLP-1) to the partnered telehealth company. The telehealth company will inevitably prescribe the medication (kickbacks is the contentious debate). In the direct cash-pay model (no middleman), patients can go to the pharmaceutical company's website, have their doctor prescribe the medication to that pharmacy, and receive it through home delivery.
That was a lot of info, but hopefully you get the point. So given all of the above, what is TrumpRx doing?
The Deets: TrumpRx
TrumpRx is the federal government’s new prescription drug portal that promises to deliver medications at “most-favored-nation” prices—meaning prices no higher than what other wealthy countries pay. It just launched with 43 drugs from five manufacturers: Pfizer, Eli Lilly, Novo Nordisk, AstraZeneca, and EMD Serono.
The administration positioned TrumpRx as a breakthrough in drug affordability. But when you look under the hood, it’s not a single system. It’s just a branded aggregator sitting on top of two main fulfillment models that already existed (Casey Langwith broke it down nicely here):
GoodRx-powered coupons: Most of TrumpRx—about 80%—runs on GoodRx infrastructure. Pfizer’s ~32 drugs and Novo Nordisk’s 3 GLP-1s all route through GoodRx. When you print a TrumpRx coupon for these medications, you’re getting a GoodRx coupon with TrumpRx branding. GoodRx confirmed it’s the “key integration partner” for TrumpRx. The mechanics are identical to what I described earlier: the patient presents the coupon at a retail pharmacy, the claim is adjudicated through a PBM, the pharmacy pays a transaction fee to the PBM, and the PBM shares part of that fee with GoodRx.
Pharmaceutical company direct-to-consumer: Eli Lilly’s Zepbound and four AstraZeneca drugs bypass the coupon model entirely. TrumpRx.gov functions as a referral link. Click on Zepbound, and you’re redirected to LillyDirect. Click on an AstraZeneca drug, and you land on their patient portal. The manufacturer controls the full transaction—pricing, fulfillment, patient data.
So, the next question you may be asking is: who’s making money from this? Just like I wrote in the above section, GoodRx and PBMs will be winning, since they’ll collect transaction fees from the pharmacy on the prescriptions filled. I imagine the federal government will be getting a split of it, too. For the Pharma D2C models, these manufacturers control pricing and capture patient data. Lilly and AstraZeneca own the relationship end-to-end. Even on the GoodRx pathway, manufacturers negotiated the “most-favored-nation” prices, so they’re setting the floor.
Below I’ll share two examples.
Medication | TrumpRx | Other D2C Platform |
|---|---|---|
Farxiga | $180 (directed to AstraZeneca) | $288 (GoodRx) |
Protonix (brand name) | $200 (coupon) | $6 (generic form, Cost Plus Drugs) |
Farxiga (brand name, no generic available) on TrumpRx routes you to AstraZeneca's direct-to-consumer platform. The next option is GoodRx at $288 (depending on location). For Protonix (brand name, but generic widely available), TrumpRx charges $200 via coupon (through GoodRx). The cheaper option is Cost Plus Drugs, where the generic costs $6.
For brand name drugs without generics, TrumpRx may help you find cheaper brand name versions.
Dashevsky’s Dissection
How will TrumpRx impact patients, physicians, and the health system—specifically, pharmacists and drug costs?
For patients, TrumpRx is a new platform to find cheaper brand name drugs through partnerships with pharmaceutical companies and GoodRx. Is it different from what's already out there? Not really. Need an AIRSUPRA inhaler and want a cheaper option than paying out of pocket (like $500)? Just go straight to AstraZeneca’s website here. TrumpRx will literally point you in the same direction. TrumpRx is a consolidated platform to help patients find cheaper prices for brand-name drugs. It's probably easier for the average American to remember “TrumpRx” to “find my cheap meds” than another niche platform. Mark Cuban would know—his name is now tightly associated with Mark Cuban Cost Plus Drugs. You mention his name, you think of his platform (or I do, at least). Trump is basically borrowing the playbook.
For physicians, we have another place to send patients if they’re having trouble affording their meds. But other than that, I'm not sure how much it’ll benefit us. (P.S., I'm publishing a white paper soon called The Physician's Guide to the Drug Supply Chain. If you'd be interested in reading this, let me know here).
Now for the health system. For now, I don’t see this bringing down drug costs unless it scales up to reach most Americans who need it. But you can’t use the platform if you have Medicare or Medicaid—a big chunk of Americans. On the CMS front, they're already making progress negotiating drug prices with drug makers—the true economic impact is TBD. I think pharmacists should be the main stakeholders we're talking about, as this is just another way they’ll be hurt financially by these coupons.
There's a great video I’ve watched probably 10 times on how coupons from GoodRx hurt pharmacies financially—you should watch it here. But to keep it simple: if a patient pays $20 for pantoprazole at their local independent pharmacy through insurance, the pharmacy keeps that $20. But if the patient uses a coupon card like GoodRx, the pharmacy only keeps, say, $13, because they need to pay a fee to GoodRx, who splits that fee with PBM(s). You may argue that it’s about patients and making medications more affordable. I agree. But independent pharmacies are also vital to our communities and neighborhoods and impact public health! Misaligned incentives are to blame.
In summary, TrumpRx is essentially a rebranded aggregator that consolidates existing discount pathways—primarily GoodRx coupons and pharmaceutical direct-to-consumer platforms—under a single government-branded portal. While it may help patients find cheaper brand name drugs more easily, it doesn't fundamentally change the economics of drug pricing or introduce new mechanisms for affordability. The real winners remain PBMs and coupon platforms collecting transaction fees, while independent pharmacies continue to absorb financial losses. For meaningful systemic change in drug costs, we’ll need solutions that address the underlying incentive misalignments rather than simply repackaging existing discount tools.
Why Most AI Tools Miss the Real Workflow
A decade-old study observed 30 primary care physicians across 17 clinics and found something striking: a routine patient visit involves 191 distinct tasks. Not 10. Not 50. 191.
Most of those tasks are invisible from a distance. Logging into the EHR. Turning back and forth between the patient and a wall-facing computer. Answering a page mid-visit. Reviewing scratch paper notes before documenting in the chart. These are the ground-level details that make or break a workflow.
Now we're in the middle of an AI implementation wave. Hundreds of companies are building ambient documentation tools, AI scribes, and clinical decision support—most of them designed by people who have never shadowed a physician. They're operating from the bird's-eye view, assuming workflows are simple and linear.
But they're not. And when these tools get deployed without understanding the actual
👉 Full breakdown in my latest Huddle+ article here.
AI Will Bring Our Nurses Back to the Bedside
In January 2026, nearly 15,000 New York City nurses went on strike. Safe staffing ratios. Workplace violence protections. Better pay. All familiar demands from their last strike three years ago.
But this time, they added something new: job security in the age of AI.
Dr. Alyssa Chen argues that AI poses a threat to nursing—but not in the way most people think. The technology isn't actually coming for bedside nurses. It's coming for the administrative roles that pulled experienced nurses away from the bedside in the first place.
She walks through the paradox: AI is automating medication refills, pre-op outreach calls, billing code capture, and quality metric reviews—all the behind-the-desk nursing work that became an escape hatch from burnout. Companies like Doctronic, Mount Sinai's AI voice agent "Sofiya," and revenue cycle optimization tools are already replacing hundreds of nursing hours.
So what happens when those administrative advancement opportunities disappear? Dr. Chen makes the case that we might actually solve the nursing shortage we've been fighting for years.
👉 Read Dr. Chen’s full argument here.
