Tariffs, TrumpRx, and the Shift to DTC Prescription Drug Sales 

The following article was first posted in the Insights section of Mercer’s website. It is reposted here with permission.

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It’s been an eventful year for the pharmacy industry, to say the least.

In April, President Trump posted executive orders aimed at lowering prescription drugs. Not even a month later, a second set of executive orders were issued to encourage more direct-to-consumer drug programs and to bring drug prices in the U.S. in line with what other countries pay—“most favored nation” pricing.

And at the end of July, Trump sent letters to CEOs at 17 pharmaceutical manufacturers, providing a 60-day notice to lower prescription drug costs in the U.S. 

Then late last month the administration posted plans via social media to impose 100% tariffs on brand-name drugs imported into the U.S.

These tariffs were to go into effect on Oct. 1, 2025, unless the manufacturer is actively building manufacturing facilities in the U.S.

As of Oct. 16, these tariffs remain on hold to provide the administration time to conduct negotiations with drugmakers on expanding domestic manufacturing and lowering drug prices.

So far, Pfizer and AstraZeneca have reached agreements that would exempt them from tariffs for three years. 

And just days after the tariffs were announced, the President revealed plans to introduce a new DTC website, TrumpRx, that would allow people to purchase drugs for cash—outside of insurance—at government-negotiated costs.

The deals struck with Pfizer and AstraZeneca include participating in TrumpRx.  

In this post, we’ll look at both the potential impact of the tariffs and what the new DTC website might mean for the U.S. pharmaceutical industry as a whole and for employer plan sponsors and their plan members.  

Tariff Impact on Employer Plans

As discussed in greater detail in this post , the new tariffs certainly have the potential to disrupt the complex global pharmaceutical supply chain, which has historically prioritized efficiency and accessibility.

That said, there are a number of reasons to believe they are unlikely to have a significant near-term impact on employer plans. 

Importantly, the announcement about the new tariffs specifically stated they will apply to branded and patented pharmaceutical products, which would mean generic drugs—the most commonly used drugs in most group plans—are unimpacted at this time.

There are a number of reasons to believe tariffs are unlikely to have a significant near-term impact on employer plans.

While branded medications typically make up about approximately 10% of drugs dispensed under the pharmacy benefit, most branded drugs are already manufactured domestically and so would also be unaffected.  

Further, many of the largest multinational drug manufacturers already have a presence in the U.S., and manufacturers with current or planned commitments to expand manufacturing in the U.S. will be exempt from tariffs. We anticipate more manufacturers will announce plans to significantly expand manufacturing in the U.S. to avoid tariffs.  

However, it is not clear at this time how tariffs will affect imports of active pharmaceutical ingredients; the European Union is a major producer of active ingredients for brand-name drugs, and India is the largest producer for generics.  

Growing Focus on DTC

While many details about TrumpRx are unknown, it would apparently act as a landing page to send patients to DTC websites offered by various drug manufacturers which have agreed to specific terms.

As mentioned, both the Pfizer and AstraZeneca agreements included their participation in TrumpRx, and we anticipate other pharmaceutical manufacturers to quickly follow their lead in offering some medications direct to consumers at a lower cost—similar to most-favored-nation pricing—through TrumpRx.  

Separately, PhRMA, the trade association for the U.S. biopharmaceutical industry, announced plans to launch a new website, AmericasMedicines.com, in January 2026.

This website will also connect patients seeking to fill prescriptions with existing DTC programs offered by individual manufacturers, although without the emphasis on achieving most-favored nation pricing.  

If these platforms move ahead as planned and are successful, it could mean the beginning of change in the pharmaceutical industry. A few observations at this point:  

• TrumpRx DTC pricing has the potential to drive greater value to consumers through deeply discounted off-insurance cash pricing, but we have yet to see how it will compare to commercial, Medicare, and Medicaid pricing.  
• Currently, only a limited number of Pfizer and AstraZenica drugs are earmarked for special pricing on TrumpRx, and most of them are not widely used. Clearly, the range of medications offered at lower prices will also determine the platform’s value.   
• PhRMA’s pricing should yield value to consumers if manufacturers are willing to provide drugs at a cost that incorporates the value of the rebate.  
• PBMs may or may not have a role with the two new DTC programs (both TrumpRx and PhRMA’s website); conceivably they might offer their services to process paper claims, administer clinical edits and apply plan design cost shares.  

DTC prescription drug sales have been introduced to the market over the past few years.

But because most people who are covered in employer health plans pay less out-of-pocket with their insurance than they would pay for the drugs directly, DTC options have had limited impact on employer plans.

However, depending on how these new platforms evolve, employers may explore ways to incorporate them into their programs with unique benefit support, such as funding health reimbursement accounts specifically for DTC drugs.  

As more information about TrumpRx and AmericasMedicines become available—neither website is currently active—we’ll be in a better situation to understand the magnitude of the impact DTC might have in lowering drug costs in the U.S.

Pharmacy continues to be one of the most dynamic spaces in healthcare today, and it’s a safe bet that the coming months will bring more announcements, pivots, and reactions—with new implications for plan sponsors and consumers. We’re committed to keeping you up to date.

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About the author: Alysha Fluno is a national pharmacy practice leader at Mercer.