The Challenge of “Direct-to-Consumer” Pharma and TrumpRx

Introduction

In 2026, the Trump administration is set to launch TrumpRx,a direct-to-consumer (DTC) drug pricing platform that will let patients buy certain brand-name prescriptions at steep cash discounts. The concept is simple: take the GoodRx® model and put it on government rails to push manufacturers to the negotiating table with tariffs.

The goal is to reduce the layers of pharmacy benefit managers (PBMs), insurers, and wholesalers that drive up prices – at least for cash pay patients. Patients will visit TrumpRx, choose their medication, and be directed to manufacturer-supported checkout pages where they can pay a significantly reduced cash price.

But here’s the catch. Even with TrumpRx, state law still requires a licensed pharmacy to process every prescription. That rule isn’t going anywhere.

Why There Still Has to Be a Pharmacy

Even in a direct-to-patient setup, prescriptions can’t go straight from a manufacturer’s warehouse to a patient’s mailbox. Every state has pharmacy laws that limit dispensing to licensed pharmacies under the supervision of licensed pharmacists.

So even if a manufacturer manages pricing and logistics, there still needs to be a pharmacy verifying the prescription, labeling the product, and providing counseling when required.

If this sounds familiar, it should. GoodRx® operates in a similar way — it helps patients find lower prices, but fulfillment still happens through licensed pharmacies. TrumpRx will follow a similar pattern, only this time with manufacturers setting the discounts and running or contracting the pharmacies behind the curtain.

This overlap between manufacturer and pharmacy activity is exactly the kind of regulatory gray area that’s been driving new rules in state compliance. For example, Alabama’s introduction of new requirements for designated representatives was a canary in a coalmine for a wave of state-level activity to align with federal DSCSA standards.

Read more in Alabama’s New Rule Has a Massive DSCSA Implication on State Regulation.

What Regulators Will Care About

State boards of pharmacy won’t reinvent the wheel for TrumpRx. They’ll keep enforcing the same principles that have always governed prescription fulfillment. The hot topics will be:

• Pharmacy licensure: Manufacturer-affiliated or contracted pharmacies will need active licenses in each state they serve.
• Pharmacist-in-Charge (PIC) oversight: Every dispensing operation needs a PIC accountable for compliance and patient safety.
• Nonresident pharmacy registration: Cross-state dispensing requires separate registration in the destination state.
• Drug Supply Chain Security Act (DSCSA) compliance: Manufacturers and pharmacies must maintain traceability.

Learn more in The Benefits of Compliance Automation in Life Sciences Supply Chain.

In short, the rules don’t change — the players just have to reconfigure how they meet them.

Cash-Pay Market Snapshot

The cash-pay market for brand-name drugs is bigger than it used to be. Around 8 to 10 percent of all brand prescriptions in the U.S. are paid in cash, and that number keeps rising as patients chase convenience and predictable pricing.

Platforms like Hims, Hers, and the expanding world of GLP-1 pharmacies have proven that patients will pay out of pocket if it means skipping insurance headaches. TrumpRx rides that same wave, amplifying a trend that’s already reshaping how consumers shop for medications.

And unlike earlier DTC models that were limited to generic drugs and telehealth startups, TrumpRx will bring the biggest manufacturers into the mix. That combination could finally force the traditional middle layers — PBMs and payers — to rethink their position in the chain.

How Manufacturers Might Adapt

To participate in TrumpRx, manufacturers will need to stay on the right side of pharmacy law. Most will either:

1. Partner with licensed mail-order pharmacies to handle prescription processing, or
2. Build  their own integrated pharmacies that operate within their corporate structures.

The second path gives manufacturers more control overpricing, brand experience, and compliance. It also means managing dozens of state licenses, pharmacist credentials, and DSCSA obligations — exactly the kind of complexity that compliance automation is built to solve.

Check out What Is Compliance Automation in the Pharmaceutical Supply Chain? fora deeper dive into how automation simplifies multi-state licensing.

The same digital tools that have been revolutionizing regulatory compliance in the life sciences will likely become standard infrastructure for these new hybrid manufacturer-pharmacies.

Read Revolutionizing Regulatory Compliance in the Life Sciences for more on that shift.

The Future of “Direct-to-Consumer”

TrumpRx will change how patients access pricing transparency, but it won’t eliminate pharmacies or regulators. It will simply pull them closer to manufacturers.

Expect the next few years to bring a mix of creativity and compliance as the industry tests what’s possible under state law. Pharmacies may evolve into fulfillment arms of manufacturers. Manufacturers may double as licensed dispensers. And states will continue playing referees to make sure safety and traceability stay intact.

Bottom Line

TrumpRx could bring manufacturer-direct pricing to millions of patients, but the road still runs through licensed pharmacies. For compliance teams, that means more licenses, more automation, and more opportunity to get ahead of the next regulatory curve.

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