Millions of Americans entered 2026 facing sharply higher health insurance costs. The enhanced Affordable Care Act (ACA) premium tax credits that helped make marketplace coverage affordable expired at the end of 2025. As a result, premiums have more than doubled on average for the roughly 22 million people enrolled in marketplace plans, and nearly 4 million are projected to lose coverage by 2034.
These pressures are unfolding alongside a worsening prescription drug affordability crisis. Americans paid a record $98 billion out-of-pocket for prescription drugs in 2024, a 25 percent increase over five years. By 2025, nearly 42 percent of Americans reported being prescribed a medication they could not afford, and 1 in 5 skipped a prescription due to cost. The burden falls hardest on uninsured adults: 24 percent rationed their medications that year, compared with 14 percent of their insured counterparts.
Rather than pursuing policies that would restore affordable coverage—and the financial protection it provides—the Trump administration is promoting a new website, TrumpRx.gov, as the answer to rising health care costs. The president has described the platform, which directs cash-paying patients to manufacturer and pharmacy coupons, as “one of the most transformative health care initiatives of all time” and one that will deliver “immediate relief” to the millions of Americans struggling with rising prescription drug prices. But a closer look reveals a stark contrast between rhetoric and reality.
As of March 16, 2026, TrumpRx lists just 54 drugs, a fraction of the thousands of medications available in the United States. Of those, 31 percent already have generic equivalents available at lower cost. Among the remainder, more than half can be found at comparable or cheaper prices through existing discount platforms such as GoodRx. And after accounting for prices already available through manufacturer coupons and patient assistance programs, only a single drug on the platform—Cetrotide, a fertility medication—offers a genuinely new lower price.
Eight barriers between patients and TrumpRx savings
TrumpRx is restricted to cash-paying patients
TrumpRx’s reach is limited by its own design. The program’s coupons cannot be combined with insurance, effectively excluding the roughly 319 million Americans—nearly 92 percent of the population—with insurance coverage.
Nearly half of uninsured Americans never reach the point of receiving a prescription
Patients need a prescription to use TrumpRx, and losing health insurance makes that far less likely. According to a KFF analysis, nearly half (46.6 percent) of uninsured adults ages 18 to 64 reported not seeing a doctor or other health professional in 2023. Applied to the estimated 27.9 million adults without insurance in 2026, this means that approximately 13 million Americans will never reach the most basic prerequisite for using TrumpRx: a visit with a clinician who can write a prescription.
Approximately 13 million Americans will never reach the most basic prerequisite for using TrumpRx: a visit with a clinician who can write a prescription.
Even when uninsured patients do interact with the health care system, those visits are less likely to result in a prescription. Uninsured adults are nearly five times more likely than their insured counterparts to lack a usual source of care, and research consistently finds they receive fewer preventive services and less treatment for chronic diseases. As coverage losses mount, these barriers to care will only grow—expanding the population TrumpRx claims to serve while making it less likely that those patients will ever reach a doctor’s office.
TrumpRx covers 0.2 percent of approved medications, and they are not the ones Americans need most
TrumpRx covers only 54 of the more than 24,000 medications approved by the Food and Drug Administration. None are generics—which account for more than 90 percent of prescriptions filled in the United States—and several account for a negligible share of prescriptions written nationwide. Two treat growth hormone deficiency, a condition affecting an estimated 0.02 percent of the U.S. population. Three are injectable fertility medications used short term during in vitro fertilization cycles, a procedure concentrated among patients who are white, privately insured, and able to afford the $21,600 average cost of a single cycle—of which medications represent only $3,000 to $7,000.
And one drug on the list—nelfinavir—is no longer used in clinical practice at all. Approved in 1997, the medication was used to treat HIV and is now classified by the National Institutes of Health (NIH) as an “archived drug,” with NIH guidelines explicitly recommending against its use due to limited efficacy and poor tolerability. The same federal government that tells clinicians not to prescribe it is now advertising a discount on it.
The inclusion of these drugs on TrumpRx suggests the platform was designed not to deliver relief to millions of Americans but to protect companies’ bottom lines. The strategy is clear: Offer eye-catching discounts on a handful of low-volume drugs that few Americans will ever use, and in exchange, receive tariff relief, positive headlines, and the freedom to continue raising prices on everything else.
Of the 54 drugs on TrumpRx, only one offers a price patients could not already get elsewhere
Seventeen of the brand-name drugs on TrumpRx have lower-cost generic equivalents—a fact the platform does not disclose. Instead, it steers patients toward brand-name versions at dramatically higher prices. Generic pantoprazole, for example, is a common acid reflux medication that costs as little as $6.36 on Cost Plus Drugs. But TrumpRx advertises only its $200 brand-name counterpart, Protonix—a thirty-onefold markup that no patient would knowingly choose. A platform built to lower costs would surface the cheaper option. TrumpRx buries it.
Among the remaining 37 drugs without lower-cost generics, GoodRx offers comparable or lower prices for 20. That leaves 17 drugs where TrumpRx appears to offer a better deal. But in 16 of those cases, the same or lower prices were already available through manufacturer coupons and patient assistance programs. After accounting for all existing discount channels, just one drug—Cetrotide, a fertility medication—offers a price that was not previously available to cash-paying patients.
TrumpRx’s advertised prices remain out of reach for the only patients who stand to benefit
TrumpRx is designed for the uninsured—a population that is overwhelmingly low income. Nearly half (46.6 percent) have family incomes below 200 percent of the federal poverty level, and more than 80 percent fall below 400 percent of the poverty level. At these income levels, even modest drug costs can be prohibitive—and TrumpRx’s prices are far from modest.
Analyses of IQVIA claims data show that patients are far less likely to fill their prescriptions as out-of-pocket costs rise. When cost-sharing is less than $10, just 7 percent of prescriptions go unfilled. At $50, that figure climbs to roughly 20 percent. At $250 or more, more than half of all prescriptions are never filled.
When compared with these thresholds, even for the 17 drugs that undercut GoodRx, TrumpRx’s prices fall squarely in the range where large shares of patients never pick up their prescriptions. Only one drug, Cetrotide, is priced lower than $30. At the low end, Mayzent ($42), Bevespi ($51), and Relenza ($53) sit in ranges where roughly 1 in 5 prescriptions are abandoned. Ovidrel ($84), Genotropin ($90), and Arnuity Ellipta ($103) reach the tier where about one-quarter are never filled. Five drugs—including Incruse Ellipta, Gonal-F, Farxiga, Xigduo XR, and Anoro Ellipta—are priced between $125 and $249, where about one-third of prescriptions go unfilled. And five drugs—including TrumpRx’s flagship Zepbound, along with Amjevita, Aimovig, and two oncology drugs exceeding $2,600—are priced at $250 or higher, well past the threshold where more than half of prescriptions are typically left at the pharmacy counter.
These figures are almost certainly conservative. IQVIA estimates are derived from commercially insured patients, and uninsured individuals forgo medications at significantly higher rates. Centers for Disease Control and Prevention data from 2021 bear this out: 22.9 percent of uninsured adults reported not taking medications as prescribed (e.g., rationing, delaying, or taking less medication) to save money—more than three and a half times the rate among privately insured adults (6.5 percent) and higher than all other coverage types.
Geographic restrictions exclude 46 million Americans
According to the TrumpRx terms and conditions, the coupons cannot be used in California or Massachusetts due to state laws restricting manufacturer coupons when a therapeutically equivalent generic is available. This leaves roughly 14 percent of the U.S. population unable to use most TrumpRx coupons based solely on where they live.
TrumpRx’s short-term discounts obscure the true cost of treatment
TrumpRx relies on a familiar pricing tactic: temporary introductory discounts that draw patients into treatment before costs rise sharply. Several drugs listed on the site advertise steep limited-time offers that apply only to the first one or two fills. Wegovy injections, for example, are advertised at $199 per month, but that price applies only to the first two fills and jumps to $349 after that—well before patients reach therapeutic maintenance dosing. Even those introductory discounts are short-lived: Promotional pricing for both Wegovy injections and pills expires this spring, just months after the program’s rollout.
Other listings impose strict refill conditions that can eliminate discounts altogether. For Zepbound, patients who fail to refill their prescription within 45 days lose the discount entirely and face prices of up to $699 per fill. Because out-of-pocket cost is the single strongest predictor of GLP-1 discontinuation, these price hikes are likely to force many patients off therapy after spending hundreds of dollars but before achieving meaningful clinical benefit.
TrumpRx bypasses deductible accumulation and out-of-pocket spending caps
Insured patients may be tempted to use TrumpRx when the advertised cash prices are lower than plan copays or when high-deductible plans require full payment for medications until the deductible is met. However, because these purchases occur outside of the insurance benefit, they do not count toward deductibles or out-of-pocket maximums—potentially increasing patients’ total costs over the course of the year.
The average deductible for employer-sponsored single coverage in 2025 was $1,886. A patient paying $199 per month through TrumpRx instead of through their plan would spend $2,388 over the year without advancing a dollar toward that threshold. For patients who take multiple medications or have high health care needs, this lost progress toward meeting deductibles can increase long-term spending—outweighing any short-term savings the coupons provide.
Conclusion
What President Donald Trump describes as “the most impactful prescription price reset in the history of our country” is, in reality, a curated directory of manufacturer coupons, nearly all of which were already available through preexisting channels. Of the 54 drugs on the platform, only one offers a price that was not already available before its launch.
Meanwhile, the administration is undermining the most powerful tool for lowering patients’ costs at the pharmacy counter: health insurance coverage. With enhanced ACA premium tax credits now expired, millions are projected to lose marketplace coverage while those who remain are paying an average of $1,016 more in annual premiums. Against those rising costs and coverage losses, a $56 discount on a single fertility medication offers little relief.
Policymakers have several tools to meaningfully lower drug prices, including restoring and expanding insurance coverage, accelerating generic and biosimilar market entry, expanding Medicare drug price negotiation, and extending negotiated prices to the commercial market. A website that consolidates existing coupons may be a convenience, but convenience is not the barrier standing between patients and their prescriptions—cost is.
The author gives special thanks to Brian Keyser and Natasha Murphy for their contributions.