President Trump has sent letters to major drug companies, urging them to lower prices in the U.S. to match the lowest prices in other developed nations under the ‘Most Favored Nation’ (MFN) policy. The White House announced on July 31 that letters were sent to companies like AstraZeneca, AbbVie, Eli Lilly, Regeneron, Novartis, and Pfizer, demanding price reductions within 60 days. Trump also shared these letters on his social media platform, Truth Social. This is not the first time the administration has pushed for the MFN policy, but this time, the language is stronger. The letters warn that if companies don’t comply, the government will use all available tools to protect Americans from high drug prices. Cyrus Fan, a research analyst, said the letters show frustration with slow progress in negotiations and are meant to pressure drugmakers into compliance. However, it’s unclear what consequences they might face if they refuse. The industry group BIO criticized the policy, saying it would lead to fewer new medicines and healthcare rationing. They suggested simplifying the system by cutting out middlemen and reforming drug reimbursement programs. Drug companies often blame ‘middlemen’—pharmacy benefit managers (PBMs)—for high prices, while PBMs argue they negotiate discounts and pass savings on to insurers. The letters ask drugmakers to offer MFN prices to Medicaid patients and commit to providing these rates for new drugs to Medicare and commercial plans. They also encourage companies to sell drugs directly to patients at prices comparable to those in other developed nations. Some experts worry that the policy lacks details on how price changes will affect what patients pay at the pharmacy. There’s also concern that reference pricing could delay drug launches in certain markets. Drug companies have previously sued to block similar price-control laws, so legal challenges may follow this executive order.