The White House announced a new direct-to-consumer (DTC) website, coined TrumpRx, for Americans to buy certain prescription drugs directly from a government website at a reduced price. Pfizer plans to offer some of its drugs on the site at the reduced rate, and in return, “gains a three-year grace period to exempt it from national security-related tariffs, as long as the company invests in domestic manufacturing.” The website is set to go live in early 2026, but details about the rollout are still unclear. Below, we dive into some of the potential implications of the TrumpRx-Pfizer deal.

Potential Implications

Changing distribution models

Without a pharmacy in between, how will patients receive their drugs from TrumpRx.gov? The shift could put pressure on 3PLs to expand dropship-to-patient capabilities or lead to new partnership models where retail pharmacies take on pickup after an online order. Either scenario introduces new distribution channels that will ripple through the drug supply chain.

If TrumpRx requires direct shipment, logistics networks will need to adjust quickly. Demand for cold-chain capacity and last-mile compliance is likely to climb, particularly with steep discounts driving higher patient uptake. Manufacturers may have to tighten service-level agreements and invest in infrastructure that safeguards product quality from the warehouse all the way to the patient.

A hybrid approach could also gain traction, with patients ordering online but collecting prescriptions in-store. That model would ease parcel strain while taking advantage of retail infrastructure, yet it would require new integrations between TrumpRx.gov, pharmacies, and manufacturers.

Over time, such changes could blur the traditional roles of distributors, pharmacy benefit managers (PBMs), and pharmacies, and also encourage manufacturers to rethink channel economics. Pharma may also look to drive out “middlemen costs” by reducing PBM rebates and rethinking channel economics.

Impact on the payer: Medicare, Medicaid, and Private

Will the rollout begin with Medicare and Medicaid, where the government is the payer, while private payers migrate in later as the model is figured out? The sequencing of adoption could define which patients benefit first, how rebate structures shift, and whether private plans are forced to adapt or resist.

The most immediate pathway is through Medicaid, where Pfizer already agreed to provide “most favored nation” pricing in exchange for exemptions from tariffs on imports. That concession could allow the government to enforce compliance and deliver savings quickly to vulnerable populations. Medicare could follow, but integrating TrumpRx.gov with Part D (currently run through private insurers and PBMs) would be more complex.

A phased rollout seems the most likely scenario: starting with cash-pay discounts through TrumpRx.gov and applying Medicaid pricing, then gradually exploring pilots with Medicare. Private payers, who rely on rebates and formulary controls, may resist integration until financial or regulatory incentives are clarified. For insurers, the risk is losing leverage in rebate negotiations if patients bypass PBM-driven formularies altogether.

Pharma companies may respond by seeking value-based pricing models in earnest, a shift that has been discussed but not widely implemented. With government pricing pressure mounting, aligning payments to patient outcomes may offer a more sustainable framework.

Increased investment in manufacturing in the U.S.

Does this shift the strategy for which drugs are produced domestically vs. overseas? As organizations balance manufacturing volume with cost-to-produce, the announcement raises new questions about how future networks will look and where production should be located.

Pfizer’s commitment to invest $70 billion in U.S. R&D and manufacturing certainly reflects the continued emphasis on domestic capacity. With the Trump administration granting a three-year exemption from national security-related tariffs in return, the move reflects a deliberate trade-off: reduced exposure to tariff risk in exchange for building out U.S. infrastructure. This suggests that high-value and politically sensitive therapies could increasingly be manufactured domestically.

Striking a Balance

Pharma companies will need to strive to have a healthy balance sheet and respond on three fronts:

1. Seek increased revenue from current drugs: It’s possible lower prices will create demand that could make up some of the lost revenue, especially on drugs where buyers have options. Companies will need to aggressively seek additional label claims to increase demand and market potential for their current portfolio. Or, they’ll need to seek value-based pricing models in earnest.
2. Identify additional income from other sources: There may be a need for global pricing rebalancing; pharma companies that have been divesting CDMO and generic/biosimilar capabilities may reinvest there to bolster their volume and profits through new balance.
3. Drive costs down: Pharma companies will need to find ways to drive costs down, like rebalancing their global supply network or finding ways to eliminate “middleman costs.” Breakthroughs in AI may help to streamline operations and further cut costs, potentially even through restructuring and layoffs.

Final Thoughts

The Trump Administration teased more agreements yet to come as part of the “most favored nation” drug pricing campaign. With overwhelming public support for lowering drug prices, and specifics about the deal still unclear, disruption is surely coming. Pharma clients can’t afford to sit still – they need to run scenario simulations, reinforce supply chain flexibility, consider commercial strategy adjustments, and evaluate financial readiness.

The Clarkston team will be monitoring the landscape and what the potential impact will be on our pharma clients. Reach out to us to chat more.