TrumpRx Discounts Come With Uncertainty Over Pharmacy Payments

Concerns about how President Donald Trump’s prescription drug website will affect pharmacies are raising questions about whether they’ll be able to afford cashing TrumpRx coupons for patients.

The TrumpRx platform debuted earlier this year and aggregates cash prices for a few dozen prescription drugs. The site’s success hinges in part on the willingness of local pharmacies to accept TrumpRx coupons, at least for drugs that aren’t funneled through a manufacturer’s dedicated mail-order pharmacy.

But lower prices also mean lower reimbursement rates for pharmacies, which must continue purchasing drugs from distributors at the same wholesale price.

The dynamic is similar to the dilemma that independent pharmacies face under pharmacy benefit managers—the companies that negotiate drug prices for insurers, which TrumpRx aims to replace. Backlash against PBMs stems in part from what state regulators say are anticompetitive tactics—such as charging patients more to use certain pharmacies or excluding them from their networks altogether—that force local pharmacies to close their doors. The National Community Pharmacists Association said 24 independent pharmacies closed in 2024.

TrumpRx’s impact on pharmacies is “the big question mark,” said Joel White, president of the Council for Affordable Health Coverage.

“Is it better or worse than PBM pricing?” White said. “I think that’s case-by-case.”

Patients are starting to bring TrumpRx coupons to the pharmacy counter, said Ronna Hauser, senior vice president of policy at NCPA. But pharmacies still don’t have confirmation on how much they’ll be paid and how long it will take to get reimbursed.

“At the end of the day, what does the math look like?” she said.

Payment Terms

Pharmacies negotiate and purchase drugs from wholesalers, which in turn purchase them from drug manufacturers. It’s not yet clear how TrumpRx prices will affect those negotiations.

So pharmacies are dispensing the drugs without knowing what their profit margins will look like, Hauser said. The concerns loom as pharmacies are navigating the same questions under Medicare’s drug price negotiation program.

“We still can’t purchase drugs from our wholesalers at that price,” she said. “So we’re purchasing at a higher price to acquire the drug, and then only getting paid a certain portion of that expense on our end.”

NCPA supports efforts to lower prices and pushed for local pharmacies to be included in TrumpRx coupons, Hauser noted. But a number of pharmacies already refuse coupons from GoodRx Inc.—the platform powering TrumpRx—over low reimbursement rates.

Eric Fromhart, co-founder of Lokol Health, a logistics firm helping independent pharmacies offer direct-to-consumer drugs, is pessimistic about uptake given TrumpRx’s reliance on GoodRx.

“It is GoodRx,” he said of TrumpRx. “Just on a different website.”

GoodRx did not respond to requests for comment.

How popular the coupons will be will also factor into whether pharmacies decide to accept them, White said. More customers means more profits, even if they’re slim.

“A lot of pharmacies are very focused on driving volumes with traffic to their retail outlets,” he said. “Because it’s not just the drug, it’s the retail store and revenue from that.”

The current impact on pharmacy margins will be small, given how few drugs are available through TrumpRx. But pharmacies might reconsider their business model if popularity grows, including by replacing percentage-based payments with flat fees, said Steve Callahan, senior director at pharmaceutical consultancy Managed Markets Insight & Technology.

“They’ll probably start to negotiate new contracts in order to stay in business and actually make sure that they’re able to meet their own margins,” he said.

Wholesalers

Wholesalers so far have escaped the majority of criticism on drug manufacturers and PBMs, but addressing their role in the supply chain is critical to lowering prices and sustaining independent pharmacies, said Dae Y. Lee, a shareholder who represents pharmacies at Buchanan Ingersoll & Rooney PC.

“We always leave out the wholesaler,” he said. “And all sellers need to come into the picture.”

White, who lobbies for wholesalers as a partner at Monument Advocacy, said the companies’ lobbying efforts are focused on educating policymakers about how the numerous existing drug pricing programs interact.

“How does all this stuff work together? And the answer is, it’s not a clean shot.” he said. “They all have whipsaw effects. They all have different incentives tied to them.”

The Healthcare Distribution Alliance declined to comment. The three largest wholesalers—Cencora Inc., McKesson Corp., and Cardinal Health Inc.—did not respond to a request for comment.

Ensuring local pharmacies stay viable will help blunt the pharmaceutical industry’s power, too.

The increasing number of partnerships between drug manufacturers, telehealth providers, and mail-order pharmacies is raising similar concerns that exist around the vertical integration of insurers, PBMs, and pharmacies—where critics say they can raise prices and block external competition.

The direct-to-consumer channel is already strengthening drugmakers’ ability to exclude local pharmacies, Lee said.

“I’ve had that issue,” he said. “I’m having that issue right now.”