President Donald Trump released a sparsely detailed healthcare policy framework Jan. 15 that calls on Congress to codify voluntary drug pricing agreements with major pharmaceutical companies, direct payments to Americans over extending enhanced ACA subsidies, and expand price transparency requirements for insurers and providers. The proposal does not identify how most of its provisions would be implemented or enforced.
Three key takeaways:
1. Drug pricing
The “Great Healthcare Plan” would formalize the administration’s “most-favored-nation” pricing model, which ties U.S. drug costs to the lowest paid by peer nations, and preserves recent HHS and CMS agreements with drugmakers. Since September, 16 of the 17 largest drugmakers, including Pfizer, Eli Lilly and Sanofi, have signed voluntary deals applying the model to portions of their portfolios. Regeneron has not yet struck a drug pricing deal with the federal government.
The discounted medications, which include treatments for cancer, Type 2 diabetes, rheumatoid arthritis, HIV, hepatitis B and C, and asthma, will also be available at most-favored-nation prices on TrumpRx, a federal direct-to-consumer website launching later this month. Several of the agreements include deep discounts on insulin and GLP-1 drugs used for diabetes and obesity.
As part of these agreements, drugmakers will sell their medications to Medicaid under the most-favored-nation pricing. Eli Lilly and Novo Nordisk have also agreed to sell Ozempic, Wegovy, Mounjaro and Zepbound to Medicare under CMS’ new voluntary BALANCE model, which will supplement access to GLP-1 drugs with no-cost lifestyle programs.
The announcement comes as Medicare implements its first negotiated drug prices under the Inflation Reduction Act. The program’s initial cycle capped costs Jan. 1 for 10 high-expenditure Medicare Part D drugs. A Vizient report released in December found that drugmakers began recalibrating pricing strategies years in advance, with many accelerating price increases for Part B and D products after the law passed in 2022.
2. Insurance costs
For the insurance industry, the plan centers on eliminating direct ACA subsidy payments to insurers in favor of sending funds to eligible Americans to purchase their own coverage. The proposal does not specify the mechanism for these payments or whether purchased plans would need to meet ACA standards, including preexisting condition protections.
Some Republicans have been pushing health savings accounts as an alternative to extending enhanced ACA subsidies, which expired at the end of 2025. In the Senate, a bipartisan group’s draft legislation would create an HSA option in the second year of a two-year subsidy extension, though that proposal is not expected to be ready until the end of January.
The plan also calls for appropriating funding for cost-sharing reductions after insurers shifted these costs onto silver plan premiums through “silver loading” starting in 2017. The proposal claims it would save at least $36 billion and reduce the most common ACA plan premiums by more than 10%. The reversal would effectively undo a Trump administration policy from his first term that ended federal payments for CSRs and led to higher silver plan premiums.
Three transparency mandates would require insurers to publish plain-language rate and coverage comparisons, claim denial rates and average wait times for routine care, and the percentage of revenues that are paid out to claims versus overhead costs and profits on their websites. A fourth provision targets PBM kickbacks to brokers.
The proposal comes as marketplace enrollment has dropped to 22.8 million for 2026, according to preliminary CMS data. The House passed a three-year subsidy extension Jan. 8, which has stalled in the Senate, and President Trump has hinted that he may veto any subsidy extension.
Congressional pressure on insurers is building ahead of dual Jan. 22 hearings where CEOs from UnitedHealth, CVS Health, Elevance, Cigna and Ascendiun (parent company of Blue Shield of California) will testify before House Energy and Commerce and Ways and Means committees. The president separately said in early January that he plans to meet with 14 insurers over industry profits.
3. Price transparency
The plan calls for any healthcare provider or insurer that accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business.
Federal price transparency laws have been in effect for hospitals since Jan. 1, 2021, and July 1, 2022, for payers.
Since the laws were enacted, 27 hospitals have been fined for price transparency violations, with the first two fines issued in June 2022. Fines for alleged violations have ranged from $32,301 for Kentwood, La.-based Southeast Regional Medical Center to $979,000 for Jacksonville, Fla.-based UF Health North. To date, no payers have been fined for price transparency violations, despite research suggesting major gaps in published data.
Two price transparency updates are slated to take effect in 2026. Starting Feb. 2, payers will be required to update their machine-readable files to the schema 2.0 format, marking the first time payer MRFs have been updated since the law took effect in 2022. The focus of the changes appears to be adding more context to prices and reducing data sizes.
Hospitals will see their own MRF changes April 1. The changes focus on three core areas: attestation language and executive accountability for file accuracy, new requirements for percentile allowed amount reporting and counts of allowed amounts, and National Provider Identifier reporting.
In December, CMS also proposed updates that would require insurers to simplify pricing data organization, reduce reporting frequency from monthly to quarterly and strengthen price comparison tools to make cost information more accessible to consumers.
The post Trump pitches healthcare policy outline aimed at lowering costs: 3 takeaways appeared first on Becker's Hospital Review | Healthcare News & Analysis.
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