A year on from President Trump’s pledge to cut Medicaid drug costs, it remains uncertain whether anything has changed. The reason for the uncertainty is simple: the administration has not made public the actual deals that underpinned the promise.
On Sept. 30, 2025, Trump announced a deal with Pfizer, saying it would be the start of a string of arrangements with drugmakers aimed at bringing down medication costs. He claimed Pfizer would make all of its prescription medicines available to Medicaid at “most favored nation” prices — the concept that U.S. drug costs should line up with what other wealthy nations pay.
The administration has reported that 26 companies entered into agreements, though none of those contracts have been released to the public. The pilot program depends on drug companies and states volunteering to take part, so the quantity of medicines that will receive reduced costs and the quantity of patients able to secure those prices may come up short against what Trump first pledged.
What Trump Said
Trump’s promise was specific. “Today Pfizer is committing to offer all of their prescription medications to Medicaid,” he said on Sept. 30, 2025. “And it will be at the most favored nation prices. It’s gonna have a huge impact on bringing Medicaid costs down like nothing else.”
He also said that he expected other drug makers to follow suit.
Who Responded to NPR
NPR contacted Pfizer and 16 other large drug companies that signed price agreements with the Trump Administration. Not one confirmed to NPR that all of their medications would be reduced in Medicaid, nor did any specify precisely which ones would receive a reduction.
A few firms singled out particular goods they were developing.
- Gilead told NPR it is working with states to make “selected covered products available,” including drugs that treat hepatitis C, hepatitis B and HIV.
- Sanofi said it would make the discounted pricing available for “certain wholly owned medicines that treat diabetes, cardiovascular and neurological conditions, and cancer.”
- Eli Lilly said it didn’t have a final list but expected “many” of its medicines to be part of the pilot program at a discount. It said “any” of its “eligible covered outpatient drugs” could be selected — except for its GLP-1 medicines that are part of another pilot program in Medicare.
- Genentech would only say that “certain medicines” would be a part of the Medicaid program.
NPR was told by two companies that the Medicaid agreements’ terms are kept secret.
Why Transparency Matters
The doctor at Brigham and Women’s Hospital in Boston fears that companies might choose which medicines to lower their prices on. Dr. Thomas Hwang argues that firms have every reason to take public credit for reductions that amount to almost nothing.
“Companies have every incentive to cherry-pick [for this program] the products for which they already give Medicaid the best discounts and for which the international price may not be that much lower,” Hwang said. “So there would be an incentive for companies to try to limit their liability and pay less to Medicaid.”
The Pilot’s Scope Is Limited
Both drug companies and states must volunteer to take part in the Generous model, which is a pilot program. The deadlines for signing up were originally set for the spring and summer, but they have since been moved back.
“It’s always a bad sign when you keep pushing back your deadline,” said Ameet Sarpatwari, a professor of population medicine at Harvard and a drug policy researcher.
States Face a Choice
Signing on carries financial risks for states, since Medicaid usually ranks as the second-biggest piece of a state’s budget after education, with the federal government sharing the cost with the states.
What Remains Unknown
No official documents have yet been published by the administration, so it remains unclear whether participating companies are required to provide Medicaid most-favored nation discounts across every single drug they produce. When asked by NPR about the specific number of each company’s drugs that would receive Medicaid discounts, the Centers for Medicare and Medicaid declined to respond.
The Bottom Line
Twelve months on from the promise of Medicaid drug discounts, the administration has yet to release the agreements that underpin it. Companies have not confirmed which drugs will be cut either. The pilot program is still voluntary, with deadlines pushed back and transparency kept limited.
The promise remains unverified.
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