The art of the deal: what are Trump’s pharma announcements really worth?

President Donald Trump speaks during an event on prescription drug prices in the Roosevelt Room of the White House, Friday, Dec. 19, 2025, in Washington as leaders from the world's biggest pharma companies look on. The Associated Press

Big Pharma announced a series of groundbreaking agreements with the White House in 2025. But how much of it is just for show? Swissinfo looks at the figures behind the headlines.

On October 10, the White House announced a deal between the United States and the British pharma giant, AstraZeneca, that included a $50 billion (CHF38.8 billion) investment in the US and the creation of 3,600 jobs. The press release also mentioned discounted prices for American patients and an asthma inhaler that would be sold at a “discount equal to 654%”.

The statement was scarce on details. The new price of the inhaler was not revealed, neither was how much Americans would be paying for AstraZeneca drugs. The company’s own press release only mentioned discounts of up to 80%.

The deal came ten days after a similar agreement with US drug manufacturer Pfizer, and was followed by a flurry of press releases made by nine executives from the world’s biggest drug companies, on their visit to the White House on December 19.

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CEOs representing Swiss pharma giants Novartis and Roche, through its American subsidiary Genentech, were in the room when President Donald Trump declared, “this is the biggest thing ever to happen on drug pricing, and on healthcare”.

But is it really? 

The details of the deals that flooded the news last year are confidential, which is common for such big investments, but behind the scenes some are sayingExternal link pharma has agreed to huge concessions to the US including low prices for new drugs to be launched in the US market. This could in turn impact prices in other countries.

Swissinfo has analysed press releases, investment plans, drug prices, company revenues and developments from the Swiss pharma industry to understand the story behind the headline. 

How big are the US investments?

In what looked like a bid to woo the US administration and avoid tariffs, in April 2025 Novartis and Roche were among the first pharma firms to announce huge investments into the US, with a combined $73 billion investment over the next five years. By comparison, over the last decade Roche has invested CHF63 billion in the US and CHF66 billion in Europe, of which CHF40 billion in Switzerland alone. 

Companies generally first agree to plans through a non-binding letter of intent, before a formal contract is finalised. Terms and conditions can differ before between the two.

Closer analysis shows that some investments aligned with earlier announcements by the same pharma companies. Roche’s April press releaseExternal link, for example, highlights a $50 billion investment that will eventually create 1,000 jobs in the US. What isn’t clear from the statement published in April is whether half of those jobs include those the company announced a month earlierExternal link regarding the expansion of an innovation centre at Harvard University.

Similarly, Novartis’ April announcementExternal link mentions investments at ten sites in the US, including a new innovation hub and nine manufacturing facilities. The expansion of three of those sites had already been presented in 2024External link.

What is clear from later statements by the two firms is that investments are going ahead. Both companies have received official approvals, signed leases with real estate firms and broken ground on construction sitesExternal link. In January 2026, Roche CEO Thomas Schinecker said he intended to raise the US share of global investment to 50%, and he confirmed his company had signed a contract with the US. He didn’t reveal if the agreement that exempts his firm from tariffs for three years also formalised the investment pledges.

What’s the impact on US drug prices?

Swissinfo has also examined the potential impact of the agreements on drug prices in the US and whether they have or will drop, as outlined in Donald Trump’s “Great Healthcare Plan”External link.

In early February 2026, the US launched TrumpRxExternal link, a federal direct-to-consumer (DTC) website that claims to list the lowest US prices for branded prescription drugs. For now, 43 drugs are available on the website, but according to the deals between pharma and the US, several other treatments will be added, including Novartis’ multiple sclerosis drug Mayzent, to be sold for $1,137 instead of the list price of $9,987, and Genentech’s flu medicine Xofluza, which would cost $50 instead of $168.

This means that on paper Novartis and Roche will sell drugs at a lower price to patients than what they currently pay. But those figures are misleading as most drugs benefit from considerable discounts and aren’t sold for the publicly available list prices.

How drug prices are set

How drug prices are set. When a drug is manufactured, the company behind it takes into consideration several criteria and proposes a price for the product. This is the list price, and it is disclosed publicly. The real price of a medication, which wholesalers pay, is decided behind closed doors. In Europe, national authorities negotiate with manufacturers to obtain the best possible country-wide price, while in the US, where the system isn’t centralised, insurance companies and intermediaries negotiate individually with drug companies. Drug prices are increasingly becoming secretive in Switzerland, and globally, net prices are purposefully kept confidential by companies to avoid countries negotiating the lowest common denominator.

TrumpRx is available to anyone in the US but is mostly appealing to uninsured Americans (roughly 8 to 10% of the population) according to experts. On top of that, most of the drugs listed have more affordable generics versions, Stat News has foundExternal link, and the platform will only include drugs that don’t require medical supervision, leaving out more expensive treatments such as immunotherapy.

Beyond DTC deals, press releases from companies and the US administration also indicate that the prices of newly commercialised innovative drugs would align to the price of Most Favoured Nation (MFN). Under MFN, US branded drug prices would be the same as a comparable high-income country (such as Switzerland). This would be a big change from the current price tag.

It’s unclear whether privately insured Americans, which represent the largest share of the US market, would benefit from these prices. For now, the measure might only be applied for patients insured under government health insurances that are geared towards the elderly and those with a low-income. Patients insured under these plans already pay little for their drugs, so experts don’t expect a significant effect of the MFN policy on prices Americans pay.

What’s the impact on pharma companies?

Excluding GLP-1 weight loss drugs, which are becoming an industry of their own, the DTC deals have the potential to save the US pharma market about $2 billion. This represents less than 0.3% of the market, estimated at $700 billion, according to ING researchExternal link.

Even so, drug companies will not be paying the difference. Instead, savings will be squeezed from pharmacy benefit managers (PBMs), US-specific middlemen that negotiate prices with manufacturers and distribute drugs to pharmacies, research shows. According to a study by the Berkeley Research Group, 50 cents of every dollar spent on branded drugs in the US goes to a party that wasn’t involved in the research or the manufacturing of the drug. PBMs get half of the amount that doesn’t go to drug manufacturers.

The products that drug makers have agreed to offer via DTC platforms aren’t their most popular, so the impact on profits will be marginal. Among the three drugs that Novartis says it will make available (Mayzent, Rydapt, and Tabrecta), none were ever in the company’s top 20 product net sales.

“We recognise it is not feasible for all medicines to be made available directly to patients. For example, many medicines must be administered in a hospital or physician setting. This was a key factor in determining which of our medicines would be accessible through TrumpRx,” a Novartis representative told Swissinfo.

The Novartis official didn’t explain why the company picked Mayzent instead of Kesimpta, a self-administered subcutaneous injection that also targets MS, albeit in a different way. Kesimpta was the company’s third top-selling drug in 2025, behind heart failure tablet Entresto and psoriasis self-injection pen, Cosentyx – which won’t be sold directly to consumers either.

It’s unclear how companies will roll out the MFN-part of the agreement. This depends on how MFN countries such as Switzerland will decide to price future drugs. Companies could set high prices for instance in the US and impose that other markets align or risk losing out on a drug completely. In 2025, Roche set a precedent when it pulled its latest cancer treatment Lunsumio from the Swiss list of reimbursed medicines over price disagreements with the national authority.

In the future experts say this could become increasingly frequent.

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In its 2025 earnings call, Novartis indicated that it was aspiring to launch its most innovative medicines, including the auto-immune drug ianalumab, across all markets in 2027, but that this  “certainly can’t adversely affect the US market”.

Although the US represents the biggest market for pharma companies and that a drop in American prices would be expected to dent sales and profit, investors don’t appear worried. Novartis and Roche have reported exceptional earnings in 2025 and while they highlight possible adverse impact on the pricing front (both from the US and Europe) both companies expect low to mid-single digit net sales in 2026. Experts say the positive outlook is due to the certainty on tariff exemptions for the next three years, and the fact that drug price reductions are for now minimal.

“It’s very hard to determine how big the effect of these negotiations were, but if you see the response of equity markets to these deals, generally speaking, they’ve been quite positive,” said Diederik Stadig, Healthcare Economist at ING.

Edited by Virginie Mangin/sb/jdp