OPINION: The reality of the TrumpRx discounts

In his recent State of the Union address, President Donald Trump touted his program designed to make drugs cheaper for Americans, called TrumpRx. He highlighted a woman in the audience who was able to purchase fertility drugs through the TrumpRx website with steep discounts. Trump said other presidents have tried to do this but only he succeeded. Being a keen observer, I’ve noticed that the president has a tendency to exaggerate, so I went to the TrumpRx website to investigate his claims.

Before focusing on the medications currently available through TrumpRx, I should point out that these medications can only be purchased through the website with cash. They are not available to any patients who are on federally funded medical plans (e.g., Medicare, Medicaid, veterans’ plans or TRICARE). Nor can people pay for the medications through their private insurance. The cash-only limitation would be a negative for people like me whose drug plans have a deductible feature. My deductible is $500. I want a drug I pay for to be applied to that deductible so I reach it as soon as possible. After that my insurance company pays.

I reviewed the list of all 43 medications on TrumpRx to see if the discounts are significant. Some reviewers have used the website GoodRx to use as a comparator. GoodRx is a website that features discounts through local pharmacies. If I go to its website and enter the name of a drug, the website will tell me what pharmacies nearby are charging for it. My Smith’s pharmacy tells me the GoodRx discount every time I use its service.

Instead, I chose businessman Mark Cuban’s website (costplusdrugs.com) as a comparator, because the Shark Tank star has a site that eliminates pharmacies as middlemen and sells drugs directly to the consumer. A substantial number of Cuban’s drugs have inexpensive generic versions. None of the medications on TrumpRx are generic. They are all brand-name drugs. Among its 43 drugs, I found 20 generic versions that are available through Cuban’s site for much lower prices. For example, a diabetes drug, metformin, can be purchased through TrumpRx for $181, but one can buy it from Cuban for $5. Likewise an antidepressant I used to prescribe when I practiced, desvenlafaxine, costs $200 on TrumpRx, whereas its generic version costs $11. Metformin and desvenlafaxine both went off patent in 2017. Am I being cynical if I suspect that pharmaceutical companies might be exploiting TrumpRx as a means of hawking their older, brand-name drugs?

Three weight loss drugs, Zepbound, Wegovy and Ozempic, are on the TrumpRx list.  If I click on the “View Details” button, I am taken to the drug company’s websites, which offer lower-priced coupons. Many pharmaceutical companies offer such discount coupons for their new medications that are very expensive and unavailable through private insurance. The coupons typically cover one to three month’s worth of medications, after which the full price kicks in. Some of my colleagues used to call this the “your first bag of cocaine is free” ploy.

Trump’s claim about the woman’s fertility drug is correct. There are two such drugs on his list that are cheaper than Cuban’s. Also, I think the concept behind the program is good. But some critics say that this program is only useful at present for the estimated 8% of patients who have no health insurance or whose insurances do not cover their meds. At this point, prescribers should talk with their patients about cost alternatives to be sure they are getting the best deal.

Jeff Mitchell is a retired psychiatrist living in Albuquerque.