Is this a return to Nixonian price controls? Or is this an effort to enforce equitable trade policy and fairness in American markets? 

Yes... kinda. Donald Trump announced yesterday that he would sign an executive order that would force drug companies to provide equal pricing for prescription medication between their domestic and international markets, part of a White House effort to seize the high ground on health care. If successful, it could reduce pressure to make cuts to benefits from Medicare and Medicaid, which would make House Republicans happy for the moment. But that's still a big if, especially when Big Pharma decides to lawyer up.

Trump announced the plan yesterday on Truth Social, wherein the plan isn't necessarily a firm price-control scheme as much as a price-equalization requirement:

The Pharmaceutical/Drug Companies would say, for years, that it was Research and Development Costs, and that all of these costs were, and would be, for no reason whatsoever, borne by the “suckers” of America, ALONE. Campaign Contributions can do wonders, but not with me, and not with the Republican Party. We are going to do the right thing, something that the Democrats have fought for many years. Therefore, I am pleased to announce that Tomorrow morning, in the White House, at 9:00 A.M., I will be signing one of the most consequential Executive Orders in our Country’s history. Prescription Drug and Pharmaceutical prices will be REDUCED, almost immediately, by 30% to 80%. They will rise throughout the World in order to equalize and, for the first time in many years, bring FAIRNESS TO AMERICA! I will be instituting a MOST FAVORED NATION’S POLICY whereby the United States will pay the same price as the Nation that pays the lowest price anywhere in the World. Our Country will finally be treated fairly, and our citizens Healthcare Costs will be reduced by numbers never even thought of before. 

The issue of the R&D costs for new pharmaceuticals is real, but it is also primarily borne by American consumers, insurance companies, and government. The high costs of drugs to Medicare Part D is a large part of the crisis that has been careening towards collapse over the last 20 years since Part D got added. That also provides the basis for Trump's ability to use an EO rather than ask Congress to pass this equalization scheme into statute, although that makes it easier to challenge, too.

The Wall Street Journal notes the wide gap between domestic and international pricing, as well as the pharmaceutical industry's strenuous objections:

Americans often pay higher sticker prices for drugs than people in other countries. For example, the list price for diabetes medication Jardiance was $611 for a 30-day supply last year, according to health research nonprofit KFF, compared with $70 in Switzerland and $35 in Japan.

The White House recently weighed legislation instituting the most-favored-nation drug policy for Medicaid, which pharmaceutical executives estimated would cost their industry more than $1 trillion over the next decade and force some companies to withdraw from the insurance program for low-income Americans.

“Government price setting in any form is bad for American patients,” said Alex Schriver, senior vice president of Pharmaceutical Research and Manufacturers of America, a trade association representing major drug companies. “At a time when we are facing growing competition from China, policymakers should focus on fixing the flaws in the U.S. system, not importing failed policies from abroad.”

The risk to innovation is real, but this isn't "price setting" in the Nixonian sense. A flat-out price control would likely kill innovation and development by removing the profit potential from the necessary capital investment. However, the wide price disparity puts the onus for covering those costs almost entirely on Americans rather than everyone who benefits from the product. The approach taken by Trump in this EO, if it's being described accurately, would allow drug companies to still set their own prices, but the US will now require the prices to be equal (or roughly equal) between foreign and domestic markets. They can cover their R&D costs and make a profit, but it will require them to do so equitably.

However, not all markets are free and fair, either. Many of these international markets operate in a single-payer system, in which the government itself is the "consumer." They then distribute the medications through their national health-care systems and absorb those secondary costs, while presenting a formidable barrier to the market without price concessions. It's very likely that the practical outcome of this equalization scheme will be that very expensive drugs simply won't sell in quantities necessary to overcome the R&D costs to produce them (and to produce future therapies). 

Politico predicts that this will end up in court -- again:

The push, which Trump announced in the White House alongside Health and Human Services Secretary Robert F. Kennedy Jr., will almost certainly draw lawsuits from the pharmaceutical industry. A federal judge struck down Trump’s most-favored nation policy during his first term in 2020 because the administration didn’t follow rulemaking procedures mandated by Congress.

“This Foreign First Pricing scheme is a bad deal for American patients,” said Steve Ubl, CEO of Pharmaceutical Research and Manufacturers of America, the lobbying arm of the brand name drug industry, in a statement. “It jeopardizes the hundreds of billions our member companies are planning to invest in America, making us more reliant on China for innovative medicines.”

The 2020 effort got largely buried by the pandemic, which may have inspired the action as a counterweight to criticism that the White House's "Operation Warp Speed" was a gift to Big Pharma. This time, the Trump administration will likely make sure to get each jot and tittle in place within the Administrative Procedure Act. 

As for allegations that Trump is imposing price controls, he fired back at the pharmaceuticals for creating their own price controls at the expense of Americans:

On accusations that signing an executive order implementing Most Favored Nation prescription drug pricing is "price control," President Trump sets the record straight:

"What was price control was before... price control was what they were doing... because at that time they had a… pic.twitter.com/RaQ8uTj7PF

— Townhall.com (@townhallcom) May 12, 2025

The devil will be in the details, but Trump might have been better off politically by asking Congress to create this price-equalization scheme instead, or at least in parallel. It would cut the legs out from under the "Fight the Oligarchy" vacation that Bernie Sanders and Alexandria Ocasio-Cortez are currently enjoying and likely would get some significant bipartisan support. Any opposition would be forced to carefully navigate a very populist electorate that very much feels that The Drug Prices Are Too Damn High, and that would be a clarifying process ... to say the least.