By the authority granted to me as President under the Constitution and the laws of the United States of America, I hereby issue the following directive:
Section 1. Purpose. The United States, despite representing less than five percent of the global population, accounts for approximately three-quarters of worldwide pharmaceutical profits. This glaring disparity is the result of a calculated strategy where drug companies heavily discount their products abroad while charging exorbitant prices domestically. For too long, American citizens have unwittingly funded not only pharmaceutical giants but also subsidized health systems in other countries. These manufacturers rely on inflated prices paid by American consumers, generous public funding for research and development through the National Institutes of Health, and significant public financing of prescription drug costs via Federal and State healthcare programs. Instead of rectifying this evident price discrimination, drug companies capitulate to foreign demands for lower prices while simultaneously opposing efforts by public and private payers in the U.S. to negotiate fairer prices for patients. The inflated costs within the United States bolster global innovation while allowing foreign health systems to benefit without contributing fairly. This exploitation of American generosity, which denies citizens access to affordable pharmaceuticals on par with other developed nations, must cease. Americans should not be compelled to pay nearly three times more for identical medications, often manufactured in the same facilities. As the largest purchaser of pharmaceuticals, it is only right that Americans receive the best possible pricing.
Sec.2. Policy. Americans should not bear the burden of subsidizing low-cost prescription drugs in other developed nations while facing inflated prices at home. Therefore, it is imperative that Americans gain access to the most-favored-nation pricing for these products. My Administration will take immediate measures to halt this global freeloading. Should drug manufacturers fail to provide American consumers with the most-favored-nation lowest prices, my Administration will pursue further aggressive actions.
Sec.3. Combating Foreign Nations’ Exploitation of American-Financed Innovation. The Secretary of Commerce and the United States Trade Representative shall undertake all necessary actions to ensure that foreign nations do not engage in unreasonable or discriminatory practices that undermine U.S. national security, particularly those that compel American patients to disproportionately fund global pharmaceutical research and development by keeping drug prices below fair market value in other countries.
Sec.4. Facilitating Direct-to-Consumer Sales at Most-Favored-Nation Pricing. To the extent permitted by law, the Secretary of Health and Human Services shall promote direct-to-consumer purchasing initiatives for pharmaceutical manufacturers that offer their products to American patients at the most-favored-nation pricing.
Sec.5. Establishing Most-Favored-Nation Pricing. (a) Within 30 days of this order, the Secretary, in collaboration with the Assistant to the President for Domestic Policy, the Administrator for the Centers for Medicare and Medicaid Services, and other relevant officials, shall communicate most-favored-nation price benchmarks to pharmaceutical manufacturers to align American patient pricing with that of similarly developed nations.
(b) If significant progress towards achieving most-favored-nation pricing for American patients is not realized following the actions outlined in subsection (a):
(i) The Secretary shall propose a rulemaking plan to enforce most-favored-nation pricing;
(ii) The Secretary shall evaluate the possibility of certifying to Congress that importation under section 804(j) of the Federal Food, Drug, and Cosmetic Act (FDCA) poses no additional public health risks and would substantially reduce prescription drug costs for American consumers. If such certification occurs, the Commissioner of Food and Drugs will act under section 804(j)(2)(B) of the FDCA to delineate conditions under which waivers will be granted for importing prescription drugs case-by-case from developed nations with lower prices;
(iii) Following the report mandated by section 13 of Executive Order 14273 of April 15, 2025 (Lowering Drug Prices by Once Again Putting Americans First), the Attorney General and the Chairman of the Federal Trade Commission shall, to the extent allowable under law, pursue enforcement actions against identified anti-competitive practices, utilizing sections 1 and 2 of the Sherman Antitrust Act and section 5 of the Federal Trade Commission Act as appropriate;
(iv) The Secretary of Commerce, along with other relevant agency heads, shall review and assess necessary actions regarding the export of pharmaceutical drugs or precursor materials that may be contributing to global price discrimination;
(v) The Commissioner of Food and Drugs shall review and potentially alter or revoke drug approvals for those products deemed unsafe, ineffective, or misrepresented in marketing;
(vi) Agency heads shall take every available action, in coordination with the Assistant to the President for Domestic Policy, to address global freeloading and the price discrimination faced by American patients.
Sec.6. General Provisions. (a) Nothing in this order shall be construed as impairing or otherwise affecting:
(i) the authority granted by law to any executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget concerning budgetary, administrative, or legislative proposals.
(b) This order will be implemented in accordance with applicable law and subject to the availability of appropriations.
(c) This order does not intend to, nor does it create any substantive or procedural right or benefit enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, or any individuals connected to them.
(d) The Department of Health and Human Services shall allocate funds for the publication of this order in the Federal Register.
DONALD J. TRUMP
THE WHITE HOUSE,
May 12, 2025.
