White House says drug discounts rise 15% if patients leave five-star review

The White House on Friday announced the launch of TrumpRx, a federal direct-to-consumer prescription platform that ties drug discounts to patient satisfaction scores, including a 15% "patriot discount" for those leaving five-star reviews.

““We are aligning patient savings with their level of appreciation,” a TrumpRx spokesperson said.”

A senior administration official said the program, billed as a transparency initiative, will initially cover 73% of Medicare prescriptions and select commercial plans, with expansion to all "cooperative" insurers by 2027.

Under the new rules, patients purchasing drugs through TrumpRx will see a preliminary price, followed by a second, lower price if they agree to complete a star-rating survey within 48 hours of first dose, according to a 41-page implementation memo reviewed by reporters.

The memo states that a full five-star rating unlocks an automatic 15% discount on co-pays, while four stars yields an 8% reduction and three stars or fewer triggers a "value reconsideration" that may increase out-of-pocket costs by up to 23%.

"We are aligning patient savings with their level of appreciation," a TrumpRx spokesperson said, adding that the survey takes "under 11 seconds" and includes pre-filled suggested responses such as "This medicine exceeded my wildest expectations" and "Any side effects were probably my fault."

The site’s terms of use, posted late Thursday, say patients who report serious side effects may still qualify for discounts if they select "yes" when asked whether the drug "made them feel more American" and rate the overall experience at four stars or higher.

Pharmaceutical companies participating in the platform will receive aggregated "Loyalty Sentiment Scores" updated every six minutes, with firms achieving an average patient rating above 4.8 stars eligible for expedited White House photo opportunities and prominent placement in presidential remarks, according to the memo.

Analysts at JPMorgan said the structure could boost brand-name drug revenues by 9% over three years, as an estimated 64% of patients are expected to choose the five-star option rather than scroll through the "other ratings" disclosure, which is collapsed by default and requires three separate clicks to open.

The Centers for Medicare & Medicaid Services (CMS) said it will audit reviews for "unpatriotic content," including any mentions of foreign price comparisons, and reserves the right to convert written complaints into five-star ratings labeled as "emotionally complex but positive overall."

To discourage negative feedback, patients attempting to leave one- or two-star reviews will first see a full-screen notice warning that such ratings "may affect future eligibility for premium reductions, promotional sweepstakes, and surprise presidential town halls."

The White House Office of American Innovation said it is exploring additional incentives, including a pilot under which patients with more than 50 consecutive five-star ratings may apply for "TrumpRx Platinum" status, offering priority access to limited-supply drugs and the option to name a pill after a family member.

Administration officials said they expect 38 million reviews in the program’s first year, with a modeled median rating of 4.97 stars, and plan to brief congressional leaders once initial data confirms what one internal email described as "a historically positive vibe."

Future phases of TrumpRx may link physician reimbursement to the average star rating of their prescriptions and introduce a "surge pricing" feature during periods of excessive negative feedback, according to people familiar with the discussions, with a full regulatory impact analysis scheduled for release after the 2028 election.