UPDATE: TrumpRx, US government's cash-pay drug purchasing portal, has arrived

After a brief delay last month, another piece of the Trump administration’s healthcare policy has fallen into place.

Thursday evening, President Donald Trump debuted TrumpRx.gov, a government-run website that directs patients toward cash-pay channels where they can purchase certain prescription drugs.

To begin, the site will feature 40 of the "most popular and expensive branded medicines" from the first five pharma companies to strike recent drug pricing deals with the White House, according to a fact sheet issued Feb. 5. Those companies are AstraZeneca, Eli Lilly, Merck KGaA's EMD Serono, Novo Nordisk and Pfizer.

Among the medications already included in the portal are Novo Nordisk's GLP-1 stalwarts Ozempic and Wegovy for diabetes and obesity, plus Novo's newly launched Wegovy pill, as well as fertility meds from EMD Serono, multiple AstraZeneca inhalers and Pfizer's eczema ointment Eucrisa.

Trump initially teased the government’s direct-to-patient drug purchasing tool back in September, simultaneously unveiling the first of now more than a dozen so-called most-favored-nation drug pricing deals with some of the pharmaceutical industry’s biggest players.

Pfizer was the first large pharma to strike a pricing deal with the White House and, as part of its commitment, pledged to offer many of its drugs at a “significant discount” through the TrumpRx.gov website. 

The company launched its TrumpRx program with 30 medicines in tow on Thursday, according to a press release, which noted that the drugs will be offered at self-pay discounts as high as 85% and closer to 50% on average.

As for how TrumpRx functions, the website lists cash prices for certain drugs using technology from GoodRx, although it does not sell the medicines directly. Instead, it directs patients to other purchasing platforms. 

In some instances, the website allows patients to print coupons that can be redeemed at participating pharmacies for certain drugs, such as Novo's obesity GLP-1 Wegovy. 

“We’re continuing to make it easier for people to access our authentic, FDA approved medicines by expanding availability through multiple, convenient options," Novo's associate VP of U.S. public affairs, Chris Pernie, said in an emailed statement to Fierce. 

The direct purchasing platforms TrumpRx links to, many of which are run by the drugmakers themselves, allow patients who aren’t using insurance to buy certain prescriptions at discounts from their list prices, although that expense is frequently still higher than it would be through insurance.

GoodRx formally revealed that it was a "core integration partner" for TrumpRx in a Thursday evening press release that coincided with the website's launch. 

Last year, Trump pressed 17 drugmakers to embrace direct-to-patient sales—among other measures—in an MFN call to action designed to balance drug prices in the U.S. with the costs paid in other developed nations.

Of the drugmakers Trump singled out, only Regeneron has yet to strike a drug pricing-deal. Those deals have prominently featured pledges from companies to list their drugs on TrumpRx, among other commitments.
 

TrumpRx's reach
 

Just how impactful the program will be at lowering medication costs for Americans remains to be seen, experts have noted.

Given that the website is expected to cater to cash-paying patients, it won’t be of much benefit to the roughly 85% of the U.S. population with prescription drug insurance coverage, the University of Washington’s Sean Sullivan, Ph.D., and Ryan Hansen, Ph.D., both professors of health economics and policy at the school, wrote in a recent opinion piece in Stat, calling TrumpRx a “distraction” from the U.S. drug pricing dilemma rather than a solution to it.

As for who would be most likely to benefit, the authors highlighted people without insurance, those with high-deductible plans and patients with high incomes who are already paying cash for drugs not typically covered by insurance, like those for weight loss, fertility or cosmetic Botox. The “real winners,” they wrote, are pharmaceutical companies themselves, which could use the ability to route patients toward cash-pay channels to “maintain higher prices while appearing magnanimous through selective discounting.”

Meanwhile, patient advocacy group Patients for Affordable Drugs Now (P4AD) had several misgivings about TrumpRx following the portal's launch. 

While the discounts on display will be especially useful for patients struggling to afford Novo and Eli Lilly's GLP-1s, "these voluntary agreements lack clear enforcement mechanisms and still put the power to set and increase prices firmly in the hands of pharmaceutical corporations," P4AD's CEO Merith Basey said in a statement Thursday. 

The nonprofit also pointed out that the pricing commitments companies have made are voluntary and not backed by statute, with no clear penalties if the drugmakers ultimately withdraw products or change their terms. TrumpRx also fails to address high wholesale acquisition costs, or list prices, which P4AD called the "underlying driver of high costs" for medicines in the U.S. 

The TrumpRx website was originally meant to go live in January but encountered a delay toward the end of the month, multiple news outlets have reported. In an interview with Politico, Brian Reid, health consultant and principal at Reid Strategic, suggested that the delay may have stemmed from antitrust concerns around the website. 

Lawmakers have also pressed concerns, with Democratic Sens. Dick Durbin of Illinois, Peter Welch of Vermont and Elizabeth Warren of Massachusetts warning the Department of Health and Human Services' (HHS') Office of Inspector General (OIG) last month that the website might violate federal anti-kickback laws.

In a letter (PDF) to the OIG, the lawmakers raised conflict-of-interest concerns and noted that a recent HHS guidance document may not adequately address whether TrumpRx complies with federal law.

“Given that oversight requests from Congress for information about the scope, structure, and legal authority underpinning the TrumpRx website have gone unanswered by HHS, and due to the lack of clarity with how HHS OIG will conduct oversight of a manufacturer’s DTC platform that is embedded in the TrumpRx website, we cannot be sure that TrumpRx will comply with existing federal laws,” the senators wrote.