White House Says MFN Drug Pricing Could Cut U.S. Drug Spending by $529 Billion Over 10 Years

The White House on Tuesday published its first consolidated case for how much money the Trump administration says its Most-Favored-Nation drug-pricing push could save, with a new Council of Economic Advisers report projecting $529 billion in lower U.S. drug spending over 10 years, including $64.3 billion in Medicaid savings.

Those figures are administration projections based on modeling, not realized savings. The White House posted a research-page item titled “Savings from Most-Favored-Nation Drug Pricing Policy” on May 5, linking to a CEA report dated May 2026.

In plain terms, the administration’s MFN approach aims to push U.S. drug prices closer to the lower prices paid in other wealthy countries. The report says the framework uses net prices — after rebates, discounts and other concessions — rather than list prices, a key distinction in the pharmaceutical market.

“The Trump Administration has designed a Most-Favored-Nation (MFN) drug pricing policy framework to address the major differences in drug prices and contributions to the pharmaceutical innovation enterprise across developed countries,” the CEA report said.

The report also said, “To date, the Administration has reached voluntary MFN pricing agreements with 17 of the largest pharmaceutical manufacturers in the world.”

A White House fact sheet issued April 23 said Regeneron was the 17th company to reach such an agreement. White House fact sheets have identified participating drugmakers, including Pfizer, AstraZeneca, Eli Lilly, Novo Nordisk, Johnson & Johnson, AbbVie and Regeneron.

The CEA said its broader prospective MFN framework for new drug launches would produce “$529B in domestic savings in the next 10 years across all markets.” Separately, it estimated $64.3 billion in federal and state Medicaid savings over 10 years for existing drugs under MFN pricing, including about $36.6 billion for the federal government and $27.6 billion for states.

The administration has paired those voluntary manufacturer agreements with a consumer-facing discount effort. The White House says TrumpRx.gov is now live, and that 16 of the 17 companies with voluntary MFN agreements had integrated discounts into the portal as of late April. The site lists discounted medicines, including GLP-1 drugs used for diabetes and weight loss, which the administration cites as early evidence the policy is reaching consumers.

The savings estimates depend on a set of assumptions laid out in the CEA report. For international comparisons, the model uses a reference basket made up of the Group of Seven countries excluding the United States, plus Denmark and Switzerland. Rather than using the single lowest foreign price, the report uses the second-lowest country price to limit the effect of outliers. It also applies adjustments tied to GDP per capita and purchasing power, along with assumptions about drug use.

A central implementation detail is the treatment of net prices, which are often not publicly available. The CEA said public net-price data are limited and that manufacturers would voluntarily report net pricing under guidance from the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare and Medicaid.

That reporting assumption matters because the administration’s case for MFN savings is built around net-price comparisons, not public list prices. In effect, the report argues that using post-rebate prices would better reflect what comparable countries and U.S. payers actually spend on medicines.

The White House also tied the report to a broader set of CMS actions already underway or proposed, underscoring that the current effort goes beyond a single rule. The CEA linked the MFN approach to the GENEROUS Medicaid model and to proposed Medicare payment models known as GLOBE and GUARD, which also rely on international benchmarking.

That broader rollout is a key difference from the administration’s earlier attempt to impose MFN pricing. In 2020, the first Trump administration advanced an MFN rule for Medicare Part B, the part of Medicare that covers physician-administered drugs, but courts blocked it before it took effect.