President Donald Trump intensified his efforts to align U.S. drug prices with international levels by sending letters to 17 major pharmaceutical companies. The letters demand that companies provide Medicaid and Medicare drugs at prices comparable to the lowest in Organisation for Economic Co-operation and Development countries with at least 60% of U.S. GDP. Additional demands include launching direct-to-consumer sales of high-rebate drugs and repatriating foreign profits. These actions follow an executive order aiming to enforce a most-favored-nation pricing framework, signaling a continued regulatory push amid industry resistance and ongoing tariff concerns. Drugmakers and trade associations have voiced concerns about these policies, citing potential impacts on innovation and market dynamics.