Trump Rx Has Pharmacies on the Struggle Bus. Only Some Are Well Positioned To Adapt
Many fertility pharmacies were already struggling. They had razor thin margins and cut anything that would be added value to clinics and patients.
Then on October 16, President Donald J. Trump’s administration announced a deal they had made with EMD Serono, who according to fertility advocates, had kept pharmacies in the dark.
Now, mandated fertility drug discounts under Trump Rx have begun reshaping expectations across the pharmacy category, even as key implementation details remain unresolved. While the program is intended to reduce patient medication costs, fertility pharmacies are still waiting for clarity on how discounted pricing will be applied operationally.
Terry Malanda, vice president of operations for Mandell’s Clinical Pharmacy in Somerset, N.J., said she has reached out directly to the Trump administration for additional guidance. “The information is just not available yet,” she told Inside Reproductive Health in November.
“EMD Serono was supposed to give us guidance two weeks ago, and we still don’t have anything” another pharmacy executive told IRH in early December.
That lack of specificity leaves fertility pharmacies unable to model how discounted drug pricing may interact with existing dispensing, logistics, and patient-support obligations tied to IVF cycles.
As a result, pharmacies are preparing for potential downstream effects before formal rules are fully defined.
Discounted drugs strain bundled service economics. Fertility pharmacies likely to begin charging for add-on services
Fertility pharmacies play a tightly integrated role in clinical care that extends well beyond filling prescriptions. Core operations commonly include temperature-controlled overnight shipping, weekend and holiday delivery, emergency replacement shipments, proactive refill coordination, injection education, insurance benefit investigation, prior authorization support, and real-time communication with clinic nursing teams when cycle timing changes.
Pharmacies frequently assist with patient communication, medication education, and insurance navigation. These services have historically been bundled into medication pricing rather than billed separately,
As drug discounts take effect, services tied to logistics, coordination, and responsiveness are increasingly under scrutiny. As fertility drug pricing compresses, pharmacies are reassessing whether long-standing bundled service models remain sustainable. The cost structure supporting fertility pharmacy operations — labor, cold-chain logistics, extended fulfillment windows, and patient support — does not decline alongside drug prices.
Patient education and clinic coordination present similar challenges. Fertility pharmacies regularly dedicate staff time to injection training, dose clarification, and mid-cycle prescription changes — services that ease clinic workflows but require pharmacy labor that is not independently reimbursed.
Insurance navigation adds another layer. Benefit verification, appeals, and coordination across payors can consume hours per patient, yet these activities are not addressed directly within drug discount frameworks.
In response, many fertility pharmacies are evaluating whether certain services may need to be unbundled and priced separately. Expedited shipping, after-hours fulfillment, emergency replacement shipments, and enhanced patient education are among the services most likely to be reviewed.
This shift is not driven by expansion strategy, but by the need to align pricing with operational reality as drug margins narrow. With even lower margins, pharmacies face increasing pressure to separate medication costs from the services required to support safe, timely fertility treatment.
Malanda said that her pharmacy was looking forward to the challenge, because of the benefit it brings to patients.
“We are keeping the patients in mind and modeling our approach in a way that will not sacrifice patient care,” she told IRH.
Clinics and Providers Turn to Proven Pharmacies, Only a Few Are Well Positioned
For fertility centers, changes in pharmacy services will introduce greater variability in the quality of their clinics’ services to patients. Many specialty pharmacies already struggle to add value to patients and are a liability to fertility centers’ patient experience. Some specialty fertility pharmacies have Google ratings as low as 2.5 from several hundred reviewers.
Providers and nurses will likely have to rely on pharmacies that have proven that they can add value to the patient experience and reduce burden on clinical staff, such as Mandell’s Clinical Pharmacy, who has a 4.8 rating on Google from hundreds of reviews.
Nursing teams, who are already overburdened, will see additional coordination demands if pharmacies reduce unpaid outreach or education, opined Rescripted CEO, Abby Mercado in an October 2025 LinkedIn post.
One fertility nurse, Tabitha explained that Mandell’s Clinical Pharmacy “made my job easier in assisting with patient communication, education, and even insurance authorization and/or finding the best price for the patient.” Another nurse, Kelly, said that Mandell’s is so helpful because they make several more attempts to contact a given patient.
2026 Will Look Much, Much Different for Pharmacies
With Trump Rx implementation details still unclear, the fertility pharmacy category is entering a period of adjustment. The coming quarters will determine whether new pricing models or reimbursement pathways emerge — or whether operational services that once remained invisible become explicit line items in fertility care.
For patients, lower medication prices may be accompanied by new service fees that are more visible and less predictable than before. While total costs may still decline in some cases, the experience of care could become more fragmented.
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