President Donald Trump has intensified pressure on pharmaceutical companies to reduce U.S. drug prices to levels comparable to other industrialized nations. Letters sent to 17 major firms demand implementation of 'most favored nation' pricing for Medicaid drugs, direct-to-consumer channels offering lower prices, and revenue repatriation from foreign markets within 60 days. Industry groups and executives argue that existing rebate systems and foreign negotiations complicate pricing, while the pharmaceutical index saw a 2% decline amid the uncertainty.