Documents › Executive orders › 14297
Executive Order 14297
Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients
Signed May 12, 2025, printed at 90 FR 20749. 5 sections of substance, 1,125 words.
This order ties American drug prices to those paid abroad. It says other lands pay far less.
Sec. 1. Purpose
The United States has less than five percent of the world's population and yet funds around three quarters of global pharmaceutical profits. This egregious imbalance is orchestrated through a purposeful scheme in which drug manufacturers deeply discount their products to access foreign markets, and subsidize that decrease through enormously high prices in the United States. The United States has for too long turned its back on Americans, who unwittingly sponsor both drug manufacturers and other countries. These entities today rely on price markups on American consumers, generous public subsidies for research and development primarily through the National Institutes of Health, and robust public financing of prescription drug consumption through Federal and State healthcare programs. Drug manufacturers, rather than seeking to equalize evident price discrimination, agree to other
The United States has less than five percent of the world's population and yet funds around three quarters of global pharmaceutical profits. This egregious imbalance is orchestrated through a purposeful scheme in which drug manufacturers deeply discount their products to access foreign markets, and subsidize that decrease through enormously high prices in the United States. The United States has for too long turned its back on Americans, who unwittingly sponsor both drug manufacturers and other countries. These entities today rely on price markups on American consumers, generous public subsidies for research and development primarily through the National Institutes of Health, and robust public financing of prescription drug consumption through Federal and State healthcare programs. Drug manufacturers, rather than seeking to equalize evident price discrimination, agree to other
This sets out the case the order makes. It says the country holds under five percent of the world's people. It says it funds about three quarters of drug profits. It says makers discount heavily abroad. It says they make that up with high prices here. It notes public money also funds the research.
Sec. 2. Policy
Americans should not be forced to subsidize low-cost prescription drugs and biologics in other developed countries, and face overcharges for the same products in the United States. Americans must therefore have access to the most-favored-nation price for these products. My Administration will take immediate steps to end global freeloading and, should drug manufacturers fail to offer American consumers the most-favored-nation lowest price, my Administration will take additional aggressive action.
Americans should not be forced to subsidize low-cost prescription drugs and biologics in other developed countries, and face overcharges for the same products in the United States. Americans must therefore have access to the most-favored-nation price for these products. My Administration will take immediate steps to end global freeloading and, should drug manufacturers fail to offer American consumers the most-favored-nation lowest price, my Administration will take additional aggressive action.
This states the policy. People here should not subsidize cheap drugs abroad. They should get the lowest price paid elsewhere. The order calls that the most favored nation price. It promises immediate steps. It warns of stronger action if makers refuse.
Sec. 3. Addressing Foreign Nations Freeloading on American-Financed Innovation
The Secretary of Commerce and the United States Trade Representative shall take all necessary and appropriate action to ensure foreign countries are not engaged in any act, policy, or practice that may be unreasonable or discriminatory or that may impair United States national security and that has the effect of forcing American patients to pay for a disproportionate amount of global pharmaceutical research and development, including by suppressing the price of pharmaceutical products below fair market value in foreign countries.
The Secretary of Commerce and the United States Trade Representative shall take all necessary and appropriate action to ensure foreign countries are not engaged in any act, policy, or practice that may be unreasonable or discriminatory or that may impair United States national security and that has the effect of forcing American patients to pay for a disproportionate amount of global pharmaceutical research and development, including by suppressing the price of pharmaceutical products below fair market value in foreign countries.
This targets other countries. Commerce and the trade office must act. The test is whether a country holds prices below fair value. Such practice would be called unreasonable. It says that shifts research costs onto patients here.
Sec. 4.
Enabling Direct-to-Consumer Sales to American Patients at the Most-Favored-Nation Price. To the extent consistent with law, the Secretary of Health and Human Services (Secretary) shall facilitate direct-to- consumer purchasing programs for pharmaceutical manufacturers that sell their products to American patients at the most-favored-nation price. [[Page 20750]]
Enabling Direct-to-Consumer Sales to American Patients at the Most-Favored-Nation Price. To the extent consistent with law, the Secretary of Health and Human Services (Secretary) shall facilitate direct-to- consumer purchasing programs for pharmaceutical manufacturers that sell their products to American patients at the most-favored-nation price. [[Page 20750]]
This opens direct sales. The health secretary must help set them up. Drug makers would sell straight to patients. The price must match the best price given abroad. That is the most favored nation price. Only makers who meet it qualify. The law sets the limits.
Sec. 5. Establishing Most-Favored-Nation Pricing
(a) Within 30 days of the date of this order, the Secretary shall, in coordination with the Assistant to the President for Domestic Policy, the Administrator for the Centers for Medicare and Medicaid Services, and other relevant executive department and agency (agency) officials, communicate most-favored-nation price targets to pharmaceutical manufacturers to bring prices for American patients in line with comparably developed nations. (b) If, following the action described in subsection (a) of this section, significant progress towards most-favored-nation pricing for American patients is not delivered, to the extent consistent with law: (i) the Secretary shall propose a rulemaking plan to impose most-favored- nation pricing; (ii) the Secretary shall consider certification to the Congress that importation under section 804(j) of the Federal Food, Drug, and Cosmetic Act (FDCA) will pose
(a) Within 30 days of the date of this order, the Secretary shall, in coordination with the Assistant to the President for Domestic Policy, the Administrator for the Centers for Medicare and Medicaid Services, and other relevant executive department and agency (agency) officials, communicate most-favored-nation price targets to pharmaceutical manufacturers to bring prices for American patients in line with comparably developed nations. (b) If, following the action described in subsection (a) of this section, significant progress towards most-favored-nation pricing for American patients is not delivered, to the extent consistent with law: (i) the Secretary shall propose a rulemaking plan to impose most-favored- nation pricing; (ii) the Secretary shall consider certification to the Congress that importation under section 804(j) of the Federal Food, Drug, and Cosmetic Act (FDCA) will pose
This sets price targets. Within 30 days the health agency must send them to drug makers. Two other officials help set them. The targets match prices in comparable countries. If prices do not fall, more follows. A rulemaking plan would then be proposed. Importing drugs is another route named.
Sec. 6. General Provisions
Every order carries this. It is not what the order does.
(a) Nothing in this order shall be construed to impair or otherwise affect: (i) the authority granted by law to an executive department or agency, or the head thereof; or (ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals. (b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations. (c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. [[Page 20751]] (d) The Department of Health and Human Services shall provide funding for publication of this order in the Federal Register. <GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT> (Presidential
(a) Nothing in this order shall be construed to impair or otherwise affect: (i) the authority granted by law to an executive department or agency, or the head thereof; or (ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals. (b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations. (c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. [[Page 20751]] (d) The Department of Health and Human Services shall provide funding for publication of this order in the Federal Register. <GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT> (Presidential
This is the closing clause that nearly every order carries. It says the order does not change what the law already allows. It also says no one can sue to enforce it.
How this order is quoted
Each section is quoted as the order prints it, under its own number and heading. Executive orders are United States government works and are not under copyright. Long sections are cut at a sentence and the whole order is a click away.