TrumpRx Debuts With Pfizer's Blessing, Insurers Game MLR Rules With Monopoly Money, and Medicare Negotiates Again

Hey all,

Happy hump day! While the administration heroically unveils government drug-buying websites and negotiates with pharmaceutical giants who've graciously agreed to lower prices in exchange for tariff exemptions and manufacturing deals, vertically integrated insurers have apparently been taking detailed notes on creative accounting—channeling inflated payments to their own provider networks while technically meeting regulatory requirements and definitely not gaming the system. The result is a healthcare landscape where we're simultaneously celebrating transparency initiatives and watching insurers perfect the art of moving money from one pocket to another, all while maintaining the institutional equivalent of a straight face. One might call this progress, though "elaborate shell game with better PR" also comes to mind.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(WSJ) White House Unveils ‘TrumpRx’ Drug-Buying Site and a Pfizer Pricing Deal

President Trump announced TrumpRx, a government-run website that will allow Americans to buy discounted drugs directly from manufacturers, with Pfizer agreeing to offer steeply reduced prices on many of its medicines. In return, Pfizer secured a three-year exemption from certain tariffs while committing to new U.S. manufacturing investments, making the deal a template for future pharmaceutical agreements. TrumpRx has become the first big aggregator of pharm-to-table offerings—though it also raises the fun question of what the eventual marketplace tax might be. Full Article

(Fierce Healthcare) Experts Warn Vertically Integrated Insurers May Skirt Medical Loss Ratio Rules

A new Health Affairs Forefront analysis suggests insurers that own provider groups could exploit value-based payment models to inflate medical spending on paper, thereby meeting medical loss ratio (MLR) requirements without necessarily improving patient care. While alternative payment models are generally viewed as progress toward value-based care, the report warns that vertical integration may enable insurers to channel inflated payments to affiliated providers, raising regulatory concerns as consolidation accelerates. But hey, no need to worry—surely we can trust health insurers not to game the system. Full Article

(Bloomberg Law) Trump Outlines Plan for Third Round of Medicare Drug Price Talks

The Trump administration issued final guidance for the third round of Medicare drug price negotiations, covering up to 15 drugs with talks starting in 2026 and prices set to take effect in 2028. The plan expands exemptions for orphan drugs, postpones action on controversial combination medicines, and clarifies how vaccines will be treated under the program. Despite strong pushback from the pharmaceutical industry, officials say the changes aim to lower costs for Medicare beneficiaries while ensuring continued drug innovation. Full Article