President Donald J. Trump issued a bold ultimatum to pharmaceutical executives on Thursday, demanding immediate action to slash drug prices—or face sweeping consequences.

White House Press Secretary Karoline Leavitt announced that President Trump sent 17 formal letters to top pharmaceutical CEOs, signaling a no-nonsense stance against what he described as “abusive drug pricing practices.” The president pledged to "deploy every tool" of the federal government to force meaningful price reductions if drugmakers fail to comply within 60 days.

Reading from the letter sent to Eli Lilly CEO David Ricks, Leavitt shared the president’s powerful language: Trump vowed to end the “global freeloading” that allows foreign nations to benefit from American innovation while U.S. families foot the bill.

“This unacceptable burden on American families ends with my administration,” the letter stated.

President Trump called for drug manufacturers operating in the U.S. to implement a four-point plan:

1. Extend “most favored nation” pricing to Medicaid,
2. Guarantee the same pricing structure for newly launched drugs,
3. Repatriate foreign revenue gains to benefit American patients and taxpayers,
4. Enable direct purchasing at most favored nation rates.

In his message, President Trump made it clear that excuses would no longer suffice. “If you refuse to step up, we’ll deploy every tool in our arsenal to protect American families from continued abusive drug pricing practices,” he wrote.

Leavitt emphasized that President Trump expects immediate and good-faith cooperation from industry leaders.

Back in May, the president issued a sweeping executive order mandating prescription drug price cuts between 30% and 80%. He shared the announcement directly with Americans via Truth Social, bypassing legacy media. The order directed the Department of Health and Human Services (HHS) to set enforceable pricing targets within 30 days.

However, Trump expressed disappointment with the subsequent negotiations, accusing pharmaceutical lobbyists of stonewalling reforms while pushing for more government handouts. “Most proposals my administration has received to ‘resolve’ this critical issue promised more of the same: shifting blame and requesting policy changes that would result in billions of dollars in handouts to industry,” he wrote in the letters, also posted to Truth Social.

“Moving forward, the only thing I will accept from drug manufacturers is a commitment that provides American families immediate relief from the vastly inflated drug prices and an end to the free ride of American innovation by European and other developed nations,” Trump added.

Trump’s May order also authorized sweeping retaliatory measures against non-compliant companies, including:

• Regulatory penalties via HHS,
• Expanded drug importation,
• Tighter reviews of U.S. drug exports,
• Revocation or modification of FDA approvals for drugs deemed unsafe, ineffective, or improperly marketed.

Predictably, the pharmaceutical lobby pushed back. Industry leaders warned that Trump’s demand for fair pricing could stifle innovation and investment—despite the fact that American taxpayers already heavily subsidize research breakthroughs.

Alex Schriver, senior vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA), told CNN: “Importing foreign price controls would undermine American leadership, hurting patients and workers.” He claimed policymakers should instead focus on middlemen and foreign freeloaders.

Some policy analysts argued that the administration may lack the statutory authority to enforce “Most Favored Nation” pricing unilaterally. Spencer Perlman of Veda Partners said a potential workaround might involve CMS Innovation Center trials, though such efforts would face legal scrutiny.

“He’s trying to put public pressure on pharmaceutical companies to voluntarily do what he does not legally have the authority to make them do,” another analyst told CNN, adding, “And no pharmaceutical company wants to be the next Harvard University, being targeted with the full power of the United States government against them.”

With American families still paying the highest drug prices in the world, President Trump’s aggressive stance may be the political pressure Big Pharma finally can't ignore.