US President Donald Trump has issued a direct ultimatum to 17 of the world’s largest pharmaceutical companies, demanding they lower the price of prescription drugs for Americans or face consequences.

In a move announced by the White House on Thursday, Trump sent signed letters to the CEOs of top drugmakers urging them to extend the “most favoured nation” pricing model to Medicaid and return excess overseas profits to US patients and taxpayers.

Trump posted individual letters he had sent to 17 drugmakers, including Pfizer, Merck, and Johnson & Johnson, on his Truth Social account. The letters set a deadline of September 29 for the companies to provide binding commitments to these demands.

“According to recent data, the prices that Americans have been paying for brand name drugs are more than three times the price other similarly developed nations pay,” said White House Press Secretary Karoline Leavitt.

The letters come after Trump signed an executive order in May, reviving a contentious plan, known as the “most favored nation” policy, that aims to slash drug costs by tying the prices of some medicines in the US to the significantly lower ones abroad.

“We will deploy every tool in our arsenal to end these practices,” Leavitt added.

While details of enforcement remain unclear, Trump’s aggressive messaging marks a return to populist themes that defined his earlier administration, with drug prices once again taking center stage in his political agenda.

“The president is calling on the companies to extend most favoured nation pricing to Medicaid… and return excess overseas revenue to American patients and taxpayers,” said the White House statement.

Critics say such pricing mandates could lead to supply disruptions or discourage innovation, but Trump’s team maintains that US consumers have been unfairly burdened for decades.

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With inputs from Reuters