Ca-ssis/istock via Getty Images

News

How TrumpRx could affect PBMs, specialty pharmacies, biotech

TrumpRx's transparent cash pricing could disrupt PBM rebate models, specialty pharmacy contracts and biotech's commercialization approaches, depending on uptake, experts say.

Alivia Kaylor, MSc
By
Published: 02 Oct 2025

President Donald Trump unveiled plans this week to launch TrumpRx.gov, a direct-to-consumer website that would let people pay out of pocket for select prescription drugs at discounted rates set by the government.

Trump said Pfizer has agreed to join the discount program and that similar deals with other drugmakers are in the works.

In a press release issued the same day, Pizer confirmed the company would participate by offering its primary care treatments and select specialty brands at savings of up to 85%, with an average discount of 50%.

The government-run platform has the potential to shake up drug pricing and commercialization strategies, with broad ripple effects, Sandy Donaldson, co-founder, president, and chief strategy officer at Impiricus, said in a statement.

"If TrumpRx drives transparency and direct-to-patient sales, it will disrupt the existing rebate-driven model across pharmacy benefit managers (PBMs), specialty pharmacies and insurers," he said.

By setting transparent cash prices for prescription drugs, TrumpRx has the potential to weaken the hidden rebate model PBMs rely on. It could also cut into specialty pharmacy contracts and force biotech companies to adjust their sales approach.

PBMs

PBMs are likely to feel the most immediate pressure if patients or insurers are able to see Pfizer's direct price through TrumpRx.

"Pfizer could point to the government's price as a new 'floor,' which erodes the cost efficiencies PBMs typically negotiate," Donaldson explained. "While PBMs may still have a role for patients outside Medicaid or Medicare, their leverage will be significantly reduced."

If more manufacturers follow Pfizer and anchor their discounts to government-negotiated cash prices, PBMs will struggle to justify their rebates as cost-saving mechanisms. This could weaken their bargaining power with insurers, who may demand that PBMs pass along deeper portions of negotiated savings.

Specialty pharmacies

Specialty pharmacies, whose business models are built around PBM contracts, could be the hardest hit.

PBMs control patient access by deciding which pharmacies are in their network and setting reimbursement rates. A specialty pharmacy needs to be contracted with the relevant PBMs managing insurance plans in order to fill prescriptions and receive payments.

"If TrumpRx gains traction and patients bypass those channels, specialty pharmacies will need to adapt or face significant financial pressure," Donaldson added.

Biotech companies

Biotech organizations could also be caught in the middle of the TrumpRx shake-up. The extent of the disruption, however, will depend on how many drugmakers ultimately agree to join.

"If more companies sign on, biotechs could see their traditional partnerships with PBMs and specialty pharmacies disrupted," Donaldson forewarned. "But if adoption remains limited, the impact may be muted."

The larger test for these companies will be adjusting commercialization strategies in a system where price transparency weakens the rebate structures that have shaped market access since the '80s.

Ultimately, the success of TrumpRx will hinge on how many patients use it and the willingness of pharmaceutical companies to participate, experts say.

"Manufacturers that join early may gain a competitive advantage, while local pharmacies and distributors could feel squeezed if patients increasingly bypass them in favor of Trump Rx. The overall supply chain will also need to adapt to a more open and direct pricing environment," Donaldson concluded.

Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.

Dig Deeper on Pharmaceuticals