President Donald Trump on Monday signed an executive order aimed at lowering prescription drug prices in the U.S. by tying costs to the lower prices often negotiated by other countries.

The order asks for drug companies to voluntarily lower their prices within 30 days, so the U.S. is paying the same amount that other wealthy countries pay for similar medications — the “most favored nation” policy. In return, the White House will support U.S. pharmaceutical companies in extracting higher prices from other countries.

If pharmaceutical companies don’t lower their prices, the administration will pursue a host of regulatory options, officials said — though specific details remain to be seen.

During a press conference Monday morning, Trump called the action “one of the most consequential executive orders in our country’s history.”

Trump claimed the order will reduce drug prices in the U.S. by “60, 70, 80, 90%” and “equalize” drug prices globally.

“‘Big Pharma’ will either abide by this principle voluntarily, or we’ll use the power of the federal government to ensure that we are paying the same price as other countries to accelerate these price restrictions and reductions,” Trump said.

White House officials said earlier Monday that the administration will open up negotiations with drug companies sometime next month and eventually pursue formal rule-making if no progress is made. It’s unclear what legal authority the administration would have to do so, particularly in extending the policy impact beyond government-run programs like Medicare and Medicaid to the private insurance market.

The officials also said the order will not focus on a specific class of pharmaceuticals, but said the administration will look at the mostly costly medications and likely include weight loss drugs.

The administration will also “communicate price targets to pharmaceutical manufacturers” and then direct the Department of Health and Human Services to “establish a mechanism” for American patients to buy drugs directly from manufacturers that lower their prices in the U.S.

The executive order is in line with Trump’s long-held view that the U.S. is subsidizing other countries and not getting enough in return.

During the press conference, the president listed various drugs, claiming that the U.S. is sometimes paying 10 times more for the price of a drug compared to other countries.

“One breast cancer drug costs Americans over $16,000 per bottle, but the same drug from the same factory manufactured by the same company is one-sixth that price in Australia and one-tenth that price in Sweden,” Trump said. “A common asthma drug costs almost $500 here in America but costs less than $40 in the United Kingdom … and the weight loss drug Ozempic costs 10 times more in the United States than in the rest of the developed world. 10 times more. Why?”

“What did we do? Suckers,” Trump added.

The Cato Institute, a libertarian think tank, praised Trump’s executive order, saying that Medicare and Medicaid pay much higher prices for medications than other countries’ government programs.

“The price that Medicare and Medicaid should be paying for drugs is $0.00,” Michael F. Cannon, a senior fellow at the Cato Institute, said in a statement. “To the extent Trump’s executive order moves the prices Medicare pays for medicines closer to the ideal price of $0.00, it is a step in the right direction.”

However, pharmaceutical companies and the medical industry have argued that lowering prices could impact the ability to research and develop new drugs.

“Importing foreign prices from socialist countries would be a bad deal for American patients and workers. It would mean less treatments and cures and would jeopardize the hundreds of billions our member companies are planning to invest in America — threatening jobs, hurting our economy and making us more reliant on China for innovative medicines,” Stephen Ubl, president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), a trade organization that represents the largest pharmaceutical companies, said in a release.

The administration said its policy will ensure that the cost is shared among several nations.

“There will still be plenty of money for research and development purposes, but it’s just the United States alone will not be bearing that cost,” a White House official said.

This is not the first time Trump has tried to lower drug prices. In 2020, during his first term, the administration issued an interim final rule implementing the “most favored nation policy” for certain Medicare drugs.

However, several district courts blocked the implementation of the rule, saying that the administration had failed to follow the proper process to implement it.