26 drugmakers have now signed "most-favored-nation" deals — here is who actually pays less

On Monday the White House announced that nine more pharmaceutical companies — Alcon, Astellas, BeOne, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva and UCB — had agreed to "most-favored-nation" pricing. That brings the count to 26 manufacturers since the first wave a year ago, a list that already includes Pfizer, Eli Lilly and Novo Nordisk. The president said the remaining 10% of the industry "have no choice" and is coming in too.

If you take a brand-name drug and have been waiting for your price to drop, the question is not whether the deals are big. They are. The question is which door the savings come through, because there are three doors and most Americans only walk through one of them.

Door one: Medicaid

The core of every MFN agreement is a commitment to give state Medicaid programs the lowest price the company charges in any comparable developed country. This is where the money is. One JAMA analysis estimated the approach could save Medicaid on the order of $8.6 billion a year, and the new deals extend it to drugs for hemophilia, Parkinson's, macular degeneration, liver disease and several cancers.

Here is the catch for the person filling the prescription: Medicaid enrollees already pay almost nothing out of pocket. Copays are capped at a few dollars by federal rule. A lower net price is good news for your state's budget and, indirectly, for the program's survival. It will not change what you hand the pharmacist. As Harvard's Luca Maini put it, "the main benefit here is not to the patients using the drugs, but to the fiscal health of the program."

Door two: TrumpRx, if you pay cash

The second channel is TrumpRx.gov, the direct-to-consumer site launched in February where participating companies list cash prices that are supposed to track MFN levels. The administration says buyers have saved more than $700 million there, and a Medicare GLP-1 program launched in July counts 500,000 seniors and $216 million in savings in two months.

Cash prices matter if you are uninsured, or if your plan puts a drug in a high tier or excludes it. They matter less if you have decent coverage, because a cash purchase does not count toward your deductible or out-of-pocket maximum, and because a New York Times review found that TrumpRx prices for many drugs are still well above what other countries pay. Treat it the way you treat a discount card: worth a look, not a substitute for insurance. Our guide to discount cards and cash prices covers when the math works.

Door three: your employer plan, which the deals do not touch

Roughly 160 million Americans get coverage through work. The MFN agreements say nothing about the prices those plans pay, nothing about pharmacy benefit managers, and nothing about your copay or coinsurance. That is the door most people actually use, and it is the one the deals leave closed.

Economists who study drug pricing also expect the long-run effect on your plan to be smaller than the headlines. Companies can raise or delay launches abroad so the "lowest foreign price" is not so low. Brigham and Women's Thomas Hwang told TIME that long-term savings "are likely illusory" for that reason. None of this makes the deals worthless. It makes them a Medicaid policy with a consumer website attached.

Voluntary means voluntary

There is a pattern with this administration's health deals, and KFF Health News documented it last week: agreements are announced on a stage, the details stay private, and enforcement is thin. Food-dye pledges were quietly pushed from 2026 to 2027 and fewer than 30% of the companies have delivered. The insurer pledge to cut prior authorization by January produced an 11% reduction and no public dashboard. The MFN contracts are likewise confidential, so nobody outside the companies and CMS can check whether the promised prices are being charged.

That is not a reason to assume the pharma deals will fail. It is a reason to read your own numbers instead of the press release.

What to actually do

If you are on a brand-name drug, price it three ways this month: your plan's cost at your pharmacy, the cash price on TrumpRx or a discount card, and the generic or biosimilar if one exists. Our guide to generics versus brand names explains when the cheaper version is genuinely the same medicine. If you take insulin, remember that the $35 cap already applies to most plans regardless of any deal.

And if your prescription needs prior authorization, that fight is unchanged by any of this. The rules for winning it are in our guide to prior authorization.

The deals lowered the price of drugs for the government. Whether they lower the price for you depends entirely on which door you are standing at.