A year after President Trump announced his first pharmaceutical pricing deal in the Oval Office, the discount website built from that push, TrumpRx.gov, is live and selling brand-name drugs like Ozempic and Wegovy directly to patients who pay cash instead of billing insurance. A second piece of the same effort, discounted pricing for the same drugs inside Medicaid, is still being assembled behind the scenes, moving through a voluntary federal pilot rather than an already-operating price cut. Medicare beneficiaries and people with private insurance sit largely outside both programs, at least for now.
What TrumpRx.gov Actually Sells Today
TrumpRx.gov launched in February 2026 as a coupon-based marketplace for roughly 40 branded medicines from the first five manufacturers to sign most-favored-nation pricing deals with the administration, with additional drugs from other manufacturers added through the year. Patients search for a drug, confirm a valid prescription, and receive a printable or phone-based coupon to present at a participating pharmacy, with pricing pegged to what the drugmaker charges in other wealthy countries.
The site’s own terms spell out who the coupons are for: a shopper must certify they are a self-pay patient with no Medicare, Medicaid, VA, TRICARE or private-insurance claim tied to the purchase, and cannot later ask an insurer for reimbursement. The White House’s own launch announcement put the monthly price of Ozempic falling from $1,028 to an average of $350, and as low as $199 for new patients in their first two fills, with injectable Wegovy following a similar discount structure.
Those figures track with the live product page for Wegovy’s pen on TrumpRx.gov itself, which lists an introductory price of $199 for new patients through the end of 2026 before the price rises to $349 or $399 a month depending on dose. The site frames every price as an out-of-pocket cash figure and specifically tells shoppers with insurance to check their copay first, since a normal Part D or commercial drug benefit can still beat the cash price for many patients.
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The Medicaid Piece Nobody Can Fully Describe Yet
The other half of the president’s pledge, made the same day in 2025 as the first pricing deal, was that Medicaid would get most-favored-nation prices on prescription drugs too. A year later, NPR’s reporting found that promise still under construction: the federal government has not released the actual pricing agreements, and none of the 16 additional manufacturers NPR contacted would confirm that all of their drugs, rather than a hand-picked subset, would carry the discount inside Medicaid.
The mechanism behind the Medicaid piece is a CMS pilot called the GENEROUS model, which launched in January 2026 and lets drug manufacturers offer states most-favored-nation pricing on covered outpatient drugs in exchange for states adopting standardized coverage rules. Participation is voluntary on both sides, and CMS’s own program page describes a five-year test rather than a nationwide change already in force, meaning a Medicaid enrollee’s actual drug price still depends on whether their state, and the manufacturer of their specific drug, has opted in.
That structure explains why the discounts can’t be described as universal yet. A state that applies and a manufacturer that participates could see meaningful Medicaid savings on a particular drug; a state that doesn’t apply, or a manufacturer that limits which products it discounts, leaves its Medicaid patients paying the same price they always did. Drug-pricing researchers have also noted that letting companies choose which products to discount gives them room to offer the drugs where the international price gap was already smallest.
Who the Savings Actually Reach
Set against that backdrop, the claim about TrumpRx holds up with one important caveat: the cash-pay discounts on TrumpRx.gov are real and available today, while the Medicaid savings are a pilot still being built rather than a price cut already reaching Medicaid patients. Both programs share the same most-favored-nation pricing logic and the same set of manufacturer deals, which is why they’re often described together even though they run on different timelines.
Medicare beneficiaries and people with employer or marketplace insurance are the group least touched by either program. TrumpRx’s own terms bar anyone using a government health program or a private-insurance claim from redeeming its coupons, and the GENEROUS model is built specifically around state Medicaid programs, not Medicare Part D or commercial drug benefits. For those beneficiaries, the price at the pharmacy is still set by their existing plan’s formulary and negotiated rates, unchanged by either initiative so far.
The practical test for both programs is the one state Medicaid directors are watching heading into 2027: how many manufacturers keep expanding their TrumpRx product lists beyond the initial roughly 40 drugs, and how many states sign binding GENEROUS agreements by the program’s own deadlines. Until those numbers are public, the accurate description of TrumpRx a year in is a working cash-discount marketplace paired with a Medicaid pricing pilot still finding its footing, not a finished overhaul of what any single group of patients pays.
Where Drug Savings Actually Show Up
Cash discounts and Medicaid pilot pricing move at different speeds, and neither one changes what a Medicare beneficiary owes at the pharmacy counter today. The practical question for most Medicare households isn’t which government program is negotiating what, but how to lower a specific drug bill or contest a coverage denial in a given month.
The Medicare Cost & Coverage Protection Kit is a 10-page kit that walks through the prior-authorization appeal steps and a medication and cost tracker for keeping every drug price change in one place.
Look up the appeal steps inside The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by The Money Overview editorial team.
