Recent developments in drug pricing highlight ongoing efforts by government programs to negotiate better prices for medications. A year after President Trump promised to lower Medicaid drug prices, questions remain about the effectiveness of these measures. States are preparing to participate in a pilot program aimed at Medicaid drug pricing, while Medicare addresses challenges related to pharmacy rebates that impact its drug price negotiation program. Insights into how Medicare selects drugs for negotiation and the potential changes affecting specialty pharmacies and market access have emerged, indicating a significant shift in the landscape of drug pricing.