The Department of Veterans Affairs announced August 13, 2026 that it has secured $10.44 billion in pharmaceutical price reductions so far in fiscal year 2026 through negotiations with drug manufacturers, up from $7.99 billion in all of FY 2025 and $5.23 billion in FY 2024. This is a dollar figure representing the cumulative value of negotiated price cuts on the drugs VA buys most, not a claim that VA’s total pharmacy spending fell by 10%; VA did not publish a percentage change in total drug spending alongside the dollar figure. With that framing in mind, how does VA’s trajectory compare with what other health care payors, including workers’ compensation systems and commercial health insurers, are actually experiencing on pharmacy costs this year?

The short answer is that VA’s negotiated savings are moving in the opposite direction from nearly every other major payor category tracked in 2026 industry data, and the gap is stark. VA’s press release credits its results in part to the second Trump administration’s broader pharmaceutical pricing push, which centers on a “Most Favored Nation” (MFN) policy tying U.S. drug prices to the lowest prices paid by comparable wealthy nations. Under an executive order President Trump signed May 12, 2025, and a series of voluntary company-by-company deals that followed, the administration has now reached MFN agreements with 17 pharmaceutical manufacturers, covering an estimated 86% of the U.S. branded drug market, in exchange for a three-year reprieve from threatened tariffs on their products. The public-facing piece of that effort, the direct-to-consumer platform TrumpRx.gov, launched in 2026 and the White House reported in August 2026 that it had generated roughly $700 million in patient savings, with prescription drug prices down 3.9% since Trump took office and falling every month of 2026, citing GLP-1 medications now available starting around $149 a month and cuts of 50% to 90% or more on drugs including fertility treatments, inhalers, insulin, and cholesterol medications.

Independent health policy analysts describe a narrower picture than the administration’s framing suggests. A June 2026 analysis characterized the MFN push as having “bold aims, but limited impact,” noting the deals mainly affect Medicaid pricing and cash-pay purchases through TrumpRx, while leaving prices largely unchanged for the roughly 92% of Americans who have private insurance, Medicare, or other coverage and fill prescriptions through their normal pharmacy benefit rather than paying cash. Reporting from STAT in early 2026 found that the specific terms of the MFN agreements have not been publicly disclosed by the administration or the companies, and that SEC filings from some participating manufacturers show the deals run for three years, after which their status is unclear. A KFF summary of the policy similarly frames it as one of several efforts underway rather than a comprehensive fix, and independent experts quoted in press coverage have pointed to factors like increased generic competition and discounted GLP-1 drugs, not the MFN deals specifically, as more plausible drivers of any broader price declines. TrumpRx.gov also does not integrate with insurance at all, meaning its savings apply only to the minority of prescriptions paid for in cash.

Set against that federal picture, the two payor categories with hard 2026 data tell very different stories from each other. On the workers’ compensation side, California’s own WCIRB 2025 Losses and Expenses Report shows pharmaceutical costs have been declining as a share of total medical payments for years, falling from 1.8% of medical payments in 2020 to 1.0% in 2025, with total pharmaceutical dollars paid actually dropping slightly, from roughly $60 million in 2024 to $52 million in 2025. That decline predates the Trump administration’s MFN push, which only began in mid-2025, and is generally attributed by industry analysts to workers’ comp-specific factors that have been underway for years: state drug formularies (California’s own formulary took effect in 2018), utilization review, and a long-running reduction in opioid prescribing within workers’ comp claims specifically. In other words, workers’ comp pharmacy costs are falling, but the trend line and its likely causes are largely independent of the federal MFN policy VA is crediting.

Commercial and employer-sponsored health insurance is moving the opposite direction, and sharply so. The 2026 Segal Health Plan Cost Trend Survey, based on responses from insurers, PBMs, and third-party administrators covering more than 80% of the commercially insured and self-insured market, projects prescription drug trend at double digits for 2026, with specialty drug trend running nearly a full percentage point higher than overall drug trend and 62% of that specialty cost growth attributable to utilization rather than price. The Business Group on Health’s 2026 employer survey similarly found employers anticipating an 11% to 12% increase in pharmacy costs heading into 2026. Pharmaceutical Strategies Group’s 2026 Artemetrx State of Specialty Spend and Trend Report, based on 204 million medical claims and 48 million pharmacy claims, put specialty drug trend at 10.8% gross and 12.5% net of rebates in 2025, continuing what it describes as a multi-year run of low double-digit growth, with GLP-1 medications alone nearly doubling their share of pharmacy spend, from 9% to 17%, in two years. None of these commercial-market figures show the kind of reduction VA and the White House are reporting; if anything, industry trend surveys describe 2026 pharmacy cost growth as among the steepest in more than a decade.

Taken together, the comparison suggests VA’s reported savings and the administration’s MFN framework are real but narrow in reach: they show up clearly in VA’s own negotiated federal purchasing and in the cash-pay, direct-to-consumer channel TrumpRx serves, and workers’ comp systems are separately seeing costs fall for reasons that predate and appear largely unrelated to the federal policy. But the commercial insurance market that covers most working-age Americans, where pricing runs through employer plans, PBMs, and rebate structures the MFN deals don’t directly touch, is still projecting double-digit pharmacy cost growth for 2026, suggesting any broader, system-wide slowdown in U.S. drug costs has not yet arrived.