Determining who did "more" depends on whether you value permanent legislative caps for seniors or immediate cash-market discounts for the general public. As of February 2026, the two approaches are competing for the "largest reduction in history" title.
The Case for Biden (Legislative & Senior-Focused)
Biden’s impact is considered more "systemic" because it changed federal law via the Inflation Reduction Act (IRA).
- Most Guaranteed Savings: He established a $2,000 annual out-of-pocket cap for the 55 million Medicare enrollees, which is a permanent legal protection.
- Direct Medicare Negotiations: His administration negotiated price drops of 38% to 79% for the first 10 major drugs, including popular blood thinners and diabetes medications.
- Budget Impact: The Medicare Policy Initiative estimated these initial negotiations alone would save the government $6 billion annually.
The Case for Trump (Market-Based & General Public)
Trump’s impact is described as more "immediate" and broad-reaching for those paying cash.
- Widest Accessibility: Unlike Biden’s Medicare-specific caps, TrumpRx.gov provides coupons and direct-buy options for over 40 popular drugs to all Americans, regardless of insurance status.
- Aggressive Specific Discounts: He secured deals to slash popular weight-loss drugs like Ozempic from over $1,000 to as low as $199–$350 for cash-paying users.
- Global Pricing Lever: His Most-Favored-Nation (MFN) agreements with 16 major pharmaceutical companies aim to force U.S. prices down to the lowest international levels.
