Trump’s health executive orders target drug prices, ACA, gender identity, WHO

In a flurry of executive orders that were signed almost as soon as he took the oath of office, President Donald Trump targeted health care, riding back some Affordable Care Act rules and ended attempts to lower prescription drug costs.

He overrode Biden’s executive order that extended the enrollment periods for ACA coverage and provided extra funding to help people enroll.

He also halted some efforts to limit Medicare and Medicaid prescription drug spending. The second round of prescription drugs up for price negotiations with drug makers –15 drugs including Ozempic and Wegovy – was announced the Friday before his inauguration.

Trump rescinded former Biden’s Executive Order 14087, “Lowering Prescription Drug Costs for Americans.” He included this directive among those he deemed to be “unpopular, inflationary, illegal, and radical practices.” The rescinded order directed Medicare and Medicaid to test ways to lower drug costs for enrollees. Those tests hadn’t started, so current drug prices are unaffected.

Trump’s executive orders did not include removing Medicare’s $35 monthly out-of-pocket price cap, which is set by law. Medicare’s $35 insulin price cap was signed into law through the Inflation Reduction Act, which means it would take another law passed by Congress to change or eliminate the price cap.

Biden’s executive order asked the Health and Human Services secretary to look into “new health care payment and delivery models that would lower drug costs and promote access to innovative drug therapies for beneficiaries enrolled in the Medicare and Medicaid programs.”

The secretary could include models “that may lead to lower cost-sharing for commonly used drugs and support value-based payment that promotes high-quality care.” This executive order was meant to complement and build off the health care cost provisions included in the Inflation Reduction Act.

Among the models that were looked into, then-HHS Secretary Xavier Becerra chose one that would have allowed Medicare Part D sponsors to offer a “Medicare-defined standard set of approximately 150 high-value generic drugs with a maximum co-payment of $2 for a month’s supply.”

Several Biden-era provisions aimed at lowering prescription costs for Medicare beneficiaries will be going into effect throughout Trump’s second term. The IRA provision limiting Medicare out-of-pocket spending on prescription drugs to $2,000 went into effect at the start of this year.

The lowered prices of the first 10 drugs picked for Medicare negotiations will go into effect at the start of 2026 and the Medicare rebate program yielded temporary savings on dozens of prescriptions last year.

One of those orders directed the Center for Medicare and Medicaid Services to test strategies to potentially reduce prescription drug costs for people on Medicare and Medicaid. Those tests hadn’t started yet, so there are no immediate changes to out-of-pocket costs for those people.

Pausing health agency communications

The National Institutes of Health has paused its grant-making process following an executive order freezing many federal health agency communications.  The freeze on forms of communication like guidance, press releases, announcements and social media posts is set to last until Feb. 1.  

“HHS has issued a pause on mass communications and public appearances that are not directly related to emergencies or critical to preserving health,” the agency said in a statement.

“This is a short pause to allow the new team to set up a process for review and prioritization. There are exceptions for announcements that HHS divisions believe are mission critical, but they will be made on a case-by-case basis.”

Exiting the World Health Organization

Trump wants the U.S. to leave the World Health Organization.

In an executive order that withdraws the U.S. from WHO in 2026, Trump cited the organization’s “mishandling of the COVID-19 pandemic” as well as what he calls “unfairly onerous payments” from the U.S.

The U.S. historically has been WHO’s biggest funder, contributing nearly $1.3 billion to the agency in the combined years 2022 and 2023.

Leaving the WHO would mean that the U.S. will no longer shape the health programs WHO funds.

The loss of U.S. funding  could hinder the WHO’s ability to swiftly and effectively respond to infectious disease outbreaks and other emergencies around the world, among others.

In exchange, the U.S. is expected to lose access to the global network that sets the flu vaccine’s composition every year.

It will also weaken the Centers for Disease Control and Prevention’s ability to surveil and contain health threats abroad, according to global health experts.

American drugmakers could lose the WHO’s help in selling their products worldwide since the WHO system endorsing drugs, vaccines and medical devices for global use that many developing countries rely on could be impaired by the loss of U.S. funding.

Only male and female

The federal government will only recognize two sexes – male and female – under another executive order that states the government will not recognize transgender or nonbinary identities.

Gender identity – as well as the health care available to people on the basis of gender identity – will be removed from federal policies and procedures.

The directive, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” defines sex as strictly male and female, based on characteristics at birth.

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