Trump Signs Bill With Major Reforms for Pharmacy Middlemen

 President Trump signed a $1.2 trillion spending package this week, provisions of which could radically change the way pharmacy benefit managers (PBMs) operate. The legislation also brought an end to a partial government shutdown that started Saturday morning.

One of the main functions of PBMs is to negotiate discounts for health plans. However, critics of the pharmacy middlemen say that PBMs have driven prices higher, rather than reining in drug costs. That's because the way reimbursement is structured, PBMs benefit from high list prices. Higher list prices on drugs mean higher rebates, and PBMs keep a portion of those rebates.

Under the new law, however, PBMs will be prohibited from linking rebates to drug companies' list prices and be required to pass through 100% of rebates to plans and sponsors.

Additionally, the legislation will require the Centers for Medicare & Medicaid Services (CMS) to establish and enforce "reasonable and relevant" contracts for Medicare Part D plans. The legislation also includes the following provisions:

• Calls for greater transparency in the generic drug and biosimilar markets
• Requires PBMs to submit semi-annual reports of drug spending, rebates, spread pricing, formulary rationale, and benefit design
• Grants CMS enforcement authority
• Creates a new designation known as "essential retail pharmacies" (defined as non-affiliated pharmacies in rural areas with no other retail pharmacy for 10 miles, or for 2 miles in suburban areas or 1 mile in urban areas)

The PBM provisions of the bill had seemed poised to be made into law toward the end of 2024 until Elon Musk, then an advisor to president-elect Trump, intervened.

Other parts of the spending package signed by Trump this week included HHS funding, such as the 2026 budget for the National Institutes of Health, temporary extensions of telehealth flexibilities for Medicare, and pandemic-era hospital-at-home flexibilities.

PBMs 'Crushing Small-Business Pharmacies'

In January 2025, a Federal Trade Commission (FTC) investigation found that the three largest PBMs -- CVS Health's Caremark Rx, Cigna's Express Scripts, and UnitedHealth's OptumRx -- inflated the prices of specialty generic drugs, including medications for heart disease and cancer, beyond their costs of acquisition, earning more than $7.3 billion in revenue from 2017 to 2022.

In addition, PBMs reimbursed affiliated pharmacies at higher rates than unaffiliated independent pharmacies for almost every one of the generic drugs that FTC staff analyzed.

The National Community Pharmacists Association (NCPA) this week applauded the new restrictions on PBM practices.

"For years, our members and we have been telling anyone who will listen -- and worked to convince others who wouldn't listen -- about the PBM-insurer conglomerates gobbling up market share, driving up drug costs, crushing small-business pharmacies, and making it more difficult for patients to receive the care they need," NCPA CEO B. Douglas Hoey, RPh, said in a press release.

"We've been warning that unless action is taken, more pharmacies will close, and more pharmacy deserts will grow. Unfortunately, as time passed, we were proven correct and finally, there is action to help reverse these trends," he said.

Hoey thanked "our champions in Congress" and President Trump for helping the provisions reach the finish line.

And Transparency-Rx called it a "game-changer" and "critical first step" toward restoring market competition.

"The provisions remove perverse incentives tied to high list prices and rebate‑driven compensation, standardize PBM definitions and guarantees across the marketplace, and strengthen contract transparency and audit rights to provide greater visibility into how rebate arrangements truly function," said the coalition of licensed transparent PBMs, in a press release.

The National Alliance of Healthcare Purchaser Coalitions called passage of the legislation "a historic milestone."

"Today's bipartisan passage is not only a policy win -- it is a long overdue correction to a system that has lacked transparency for far too long," said Shawn Gremminger, the organization's president and CEO, in a press release. "For years, employers have navigated a healthcare marketplace where critical information about pricing, rebates, and formulary decisions was kept out of view. These reforms finally level the playing field and put employers and working families first."

Pharmaceutical Care Management Association, the lobbying group for PBMs, expressed its disappointment with the spending bill.

"The pharmaceutical industry deserves serious credit for this campaign, which managed to persuade people that discounts are in fact bad, and PBM transparency, somehow, is the roadblock to falling drug prices," Brendan Buck, the association's chief communications officer, wrote in an open letter. "It's absurd on its face. But it worked."

FTC Targets Insulin Markups

In addition to the changes Congress made, the FTC announced on Wednesday a settlement with Express Scripts requiring it to make certain changes in its practices that would increase transparency and lead to lower prices.

The change made by the settlement are projected to lower patients' out-of-pocket costs for certain drugs, including insulin, by up to $7 billion over 10 years, the FTC said.

FTC's lawsuit claimed Express Scripts had "artificially inflated the list price of insulin drugs by using anticompetitive and unfair rebating practices, and impaired patients' access to lower list price products, ultimately shifting the cost of high insulin list prices to vulnerable patients," according to a press release.

"The FTC's settlement with [Express Scripts] will end its business practices that have kept drug prices high, ultimately providing meaningful financial relief to American patients who depend on [Express Scripts] to access life-sustaining prescription drugs as well as community pharmacies who will see new revenues each year and relief from being squeezed," said FTC Chairman Andrew N. Ferguson.

NCPA's Hoey said the settlement "will help lower consumers' copays that have been tied to artificially inflated prices that feed Cigna's insatiable appetite for more and more rebates and GPO [Group Purchasing Organization] fees."

"The settlement also obliterates the big-PBM industry fiction that they work to lower the cost of drugs for Americans. Obviously, the opposite appears to be true," he added. "I hope this is only the beginning of righting the games leading to higher drug prices and harming competition."

https://www.medpagetoday.com/washington-watch/reform/119762

FDA Calls for Testing Before Treatment With Widely Used Chemotherapies

 Oncology specialists should inform patients about a risk of serious toxicity related to dihydropyrimidine dehydrogenase (DPD) deficiency and should test for DPYD variants before starting treatment with capecitabine (Xeloda) and fluorouracil, the FDA announced.

In a safety update communication, the agency noted that DPYD encodes DPD, which breaks down more than 80% of fluorouracil. Certain homozygous or compound heterozygous DPYD variants result in complete or near-complete absence of DPD activity, increasing the risk for serious, potentially fatal toxicities when exposed to capecitabine or fluorouracil, which are widely used in cancer treatment. Potential adverse reactions include mucositis, diarrhea, neutropenia, and neurotoxicity. The reactions also can occur in patients who have partial DPD activity.

Capecitabine and fluorouracil, or 5-FU, are routinely used in treatment regimens for breast, colorectal, gastric, and pancreatic cancers.

The update adds to previously approved labeling revisions, incorporating more information on DPD deficiency. The revisions include a boxed warning about potentially serious adverse reactions and deaths in patients with complete DPD deficiency. Oncologists are advised to test patients for DPYD variants prior to initiating treatment with the drugs, unless immediate treatment is necessary. 

A new subsection of the product labels' dosing and administration section advises oncologists to avoid capecitabine and fluorouracil in patients who have variants that result in complete DPD deficiency. Dosing should be individualized for patients with partial DPD deficiency.

An estimated 2 million patients worldwide receive the fluoropyrimidines capecitabine and fluorouracil each year. Though widely used, the drugs have a narrow therapeutic index, as 30-40% of patients treated with the drugs develop grade ≥3 toxicity, and up to 1% of adverse reactions prove to be fatal.

https://www.medpagetoday.com/hematologyoncology/othercancers/119774

'KFF: As ICE Uses Medicaid Data, Hospitals in Bind Over Warning Immigrant Patients'

 The Trump administration's move to give deportation officials access to Medicaid data is putting hospitals and states in a bind as they weigh whether to alert immigrant patients that their personal information, including home addresses, could be used in efforts to remove them from the country.

Warning patients could deter them from signing up for a program called Emergency Medicaid, through which the government reimburses hospitals for the cost of emergency treatment for immigrants who are ineligible for standard Medicaid coverage.

But if hospitals don't disclose that the patients' information is shared with federal law enforcement, they might not know that their medical coverage puts them at risk of being located by Immigration and Customs Enforcement (ICE).

"If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment," said Leonardo Cuello, a research professor at Georgetown University's Center for Children and Families. "Half of the Emergency Medicaid cases are for the delivery of U.S. citizen babies. Do we want these mothers avoiding the hospital when they go into labor?"

For more than a decade, hospitals and states have assured patients that their personal information, including their home addresses and immigration status, would not be shared with immigration enforcement officials when they apply for federal healthcare coverage. A 2013 ICE policy memo guaranteed the agency would not use information from health coverage applications for enforcement activities.

But that changed last year, after President Donald Trump returned to the White House and ordered one of the most aggressive immigration crackdowns in recent history. His administration began funneling data from a variety of government agencies to the Department of Homeland Security, including tax information filed with the Internal Revenue Service.

CMS, part of HHS, agreed last spring to give ICE officials direct access to a Medicaid database that includes enrollees' addresses and citizenship status.

Twenty-two states, all but one led by Democratic governors, sued to block the Medicaid data-sharing agreement, which the administration did not formally announce until a federal judge ordered it to do so last summer. The judge ruled in December that in those states, ICE could access information in the Medicaid database only about people in the country unlawfully. KFF Health News contacted more than a dozen hospitals and hospital associations in states and cities that have been targets of ICE sweeps. Many declined to comment on whether they've updated their disclosure policies after the ruling.

Of those that responded, none said they are directly warning patients that their personal information may be shared with ICE when they apply for Medicaid coverage.

"We do not provide legal advice about federal government data-sharing between agencies," Aimee Jordan, a spokesperson for M Health Fairview, a Minneapolis-based hospital system, said in an email to KFF Health News. "We encourage patients with questions about benefits or immigration-related concerns to seek guidance from appropriate state resources and qualified legal counsel."

Information on Applications

Some states' Emergency Medicaid applications specifically ask for a patient's immigration status -- and still assure people that their information will be kept secure and out of the hands of immigration enforcement officials.

For example, as of Feb. 3, California's application still included language advising applicants that their immigration information is "confidential."

"We only use it to see if you qualify for health insurance," states the 44-page form, which the state's Medicaid program, known as Medi-Cal, posted on social media in January.

California Department of Health Care Services spokesperson Anthony Cava said in a statement that the agency, which oversees Medi-Cal, will "ensure that Californians have accurate information on the privacy of their data, including by revising additional publications as necessary."

Until late January, Utah's Medicaid website also claimed its Emergency Medicaid program did not share its information with immigration officials. After KFF Health News contacted the state agency, Kolbi Young, a spokesperson, said Jan. 23 that the language would be taken down immediately. It was removed that day.

Oregon Health & Science University, a hospital system based in Portland, offers immigrant patients a Q&A document developed by the state Medicaid program for those with concerns about how their information might be used. The document does not directly say that Medicaid enrollees' information is shared with ICE officials.

Hospitals rely on Emergency Medicaid to reimburse them for treating people who would qualify for Medicaid if not for their citizenship status -- those in the country illegally and lawfully present immigrants, such as those with a student or work visa. The coverage pays only for emergency medical and pregnancy care. Typically, hospital representatives help patients apply while they are still in the medical facility.

The main Medicaid program, which covers a much broader range of services for over 77 million low-income and disabled people, does not cover people living in the country illegally.

Examining Emergency Medicaid enrollment is the most obvious way, then, for deportation officials to identify immigrants, including those who might not reside in the U.S. lawfully.

HHS spokesperson Rich Danker said in an email that CMS -- which oversees Medicaid, a joint state-federal program -- is sharing data with ICE after the judge's ruling. But he would not answer how the agency is ensuring it is sharing information only on people who are not lawfully present, as the judge required.

With ICE now getting direct access to the personal information of millions of Medicaid enrollees, hospitals -- while "definitely in a tough position" -- should be up-front about the changes, said Sarah Grusin, an attorney at the National Health Law Program, an advocacy group.

"They need to be telling people that the judge has permitted sharing of information, including their address, for people who are not lawfully residing," she said. "Once this information is submitted, you can't protect it from disclosure at this point."

Grusin said she advises families to weigh the importance of seeking medical care against the risk of having their information shared with ICE.

"We want to give candid, honest information even if it means the decision people have to make is really hard," she said.

Those who have previously enrolled in Medicaid or can easily search their address online should assume that immigration officials already have their information, she added.

Emergency Medicaid

Emergency Medicaid coverage was established in the mid-1980s, when a federal law began requiring hospitals to treat and stabilize all patients who show up at their doors with a life-threatening condition.

Federal government spending on Emergency Medicaid accounted for nearly $4 billion in 2023, or about 0.4% of total federal spending on Medicaid.

States send monthly reports to the federal government with detailed information about who enrolls in Medicaid and what services they receive. The judge's ruling in December limited what CMS can share with ICE to only basic information, including addresses, about Medicaid enrollees in the 22 states that sued over the data-sharing arrangement. ICE officials are not supposed to access information about the medical services people receive, per the judge's order.

The judge also prohibited the agency from sharing the data of U.S. citizens or lawfully present immigrants from those states.

Deportation officials have access to personal Medicaid information of all enrollees in the remaining 28 states.

The federal health agency has not clarified how it is ensuring that certain states' information on citizens and legal residents is not shared with ICE. But Medicaid experts say it would be nearly impossible for the agency to separate the data, raising questions about whether the Trump administration is complying with the judge's order.

The Trump administration's efforts to deport immigrants living in the country illegally have had implications on immigrant families seeking care. About a third of adult immigrants reported skipping or postponing healthcare in the past year, according to a KFF/New York Times poll released in November. (KFF is a health information nonprofit that includes KFF Health News.)

Bethany Pray, the chief legal and policy officer at the Colorado Center on Law and Policy, warned that sharing Medicaid data directly with deportation officials will force even tougher decisions upon some families.

"This is very concerning," Pray said. "People should not have to choose between giving birth in a hospital and wondering if that means they risk deportation."

https://www.medpagetoday.com/washington-watch/washington-watch/119775

Gabapentin Misuse Persists, non-medical use is often combined with opioids

 

• Non-medical gabapentin use remains prevalent, data from two studies suggested.
• Most adverse event cases involving non-prescribed gabapentin included multiple substances, especially opioids.
• Clinicians should remain vigilant for misuse and polysubstance risks, researchers warned.

Two analyses suggested that non-medical (illicit) gabapentin use persisted in recent years as patterns in prescribing shifted.

The first analysis, led by Sara Karami, PhD, MPH, of the FDA's Center for Drug Evaluation and Research, reviewed U.S. poison center data from 2013 to 2023 and found 196,903 adverse event cases involving non-prescribed gabapentin.

Cases involving non-prescribed gabapentin increased between 2013 and 2017 but then declined through 2022, mirroring a rise and subsequent stabilization in gabapentin prescriptions over the same period, according to Karami and colleagues in Drug and Alcohol Dependence.

The second analysis focused on urine drug tests from substance use disorder (SUD) treatment centers between 2016 and 2023. During that period, the rate of gabapentin use without a prescription (11.3%) was nearly double that of prescribed use (5.9%).

Over time, non-prescribed gabapentin use among SUD patients fell from 15.2% in 2016 to 9.9% in 2023, while prescribed use rose from 3.9% to 7.6%, reported Matthew Ellis, MD, PhD, of Washington University in St. Louis, and colleagues in Drug and Alcohol Dependence.

Gabapentin prescriptions are increasing in substance use treatment settings, Ellis observed. "But the finding that strikes me most is the positivity rate for people not prescribed gabapentin," he told MedPage Today. "These patients are using gabapentin outside of prescriptions at about double the rate of those who were actually prescribed it."

The analysis also showed that non-prescribed gabapentin use was strongly related to opioid use disorder (OUD), Ellis said. Other reports have indicated that people with OUD may use gabapentin to potentiate the effects of buprenorphine and methadone, self-manage withdrawal, or self-treat mental and physical comorbidities, he noted.

Both studies echoed trends seen in other research, including a CDC analysis which found that gabapentin prescribing rates doubled between 2010 to 2016, but increased more slowly from 2016 to 2022.

Prescription rates started to fall after the FDA warned about potential central nervous system (CNS) side effects associated with gabapentinoids, Karami and colleagues observed.

In 2018 and 2019, the FDA cautioned about serious breathing problems for patients who used gabapentinoids with opioids or other drugs that depress the CNS, or those who had conditions like chronic obstructive pulmonary disease that reduce lung function.

Gabapentin is approved by the FDA for seizures and postherpetic neuralgia; gabapentin enacarbil is approved for restless legs syndrome. Despite limited indications, gabapentin and its cousin pregabalin are widely prescribed off-label for chronic pain or other conditions, including alcohol use disorder and OUD.

In their study, Karami and co-authors analyzed prescription drug dispensing in Symphony Health's Metys database and adverse events from the National Poison Data System for gabapentin and three comparator drugs: pregabalin, diazepam, and oxycodone.

Between 2013 and 2022, non-medical gabapentin case rates were similar to those for pregabalin, while diazepam and oxycodone had higher rates. Most adverse event cases involving non-prescribed gabapentin (68%) or comparator drugs (55% to 80%) included multiple substances, especially opioids.

"Because gabapentin is frequently prescribed as part of opioid-sparing protocols, it is important for clinicians and patients to be aware that gabapentin is also used non-therapeutically, and that acute harms may be more severe" when gabapentin and opioids are used together, Karami and colleagues noted.

In the second analysis, Ellis and colleagues reviewed 206,161 urine drug tests from SUD treatment practices using Millennium Health records from 2016 to 2023. Specimens were tested for gabapentin and other drugs, with prescribed medications documented separately.

SUD patients who used non-medical gabapentin were more likely to have sedative use disorder (adjusted OR 1.54) or OUD (adjusted OR 2.00) compared with other SUD patients.

"Although there is debate about the abuse/addictive potential of gabapentin, there are clear, positive associations between a history of substance use and likelihood of engaging in the non-medical use of gabapentin," Ellis and co-authors noted.

Patients with SUD should be carefully monitored for polysubstance use, and "harm reduction efforts should include information about gabapentin-associated risks to persons who use drugs," they added.

Both analyses were based on observational data and causal relationships could not be determined. Both also were subject to the limitations of the databases that the researchers used.

More work is needed "to understand drivers of gabapentin use outside of a prescription, such as the role of polysubstance use or gaps in care," Ellis and colleagues wrote.

Disclosures

Karami and colleagues had no disclosures.

The urine drug test analysis was supported by Millennium Health.

Ellis reported conducting this research in collaboration with Millennium Health through an unpaid consulting agreement; he is a member of the Scientific Advisory Group for the National Drug Early Warning System and receives support from Denver Health and Hospital Authority and the National Institute on Drug Abuse. Co-authors reported relationships with Millennium.

Primary Source

Drug and Alcohol Dependence

Source Reference: Karami S, et al "Gabapentin utilization and nontherapeutic use relative to select comparator drugs, United States 2013-2022" Drug Alcohol Depend 2026; DOI: 10.1016/j.drugalcdep.2026.113026.

Secondary Source

Drug and Alcohol Dependence

Source Reference: Ellis MS, et al "Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016-2023" Drug Alcohol Depend 2026; DOI: 10.1016/j.drugalcdep.2026.113020.

https://www.medpagetoday.com/neurology/painmanagement/119776

Headwinds in GoodRx's (GDRX) Drug Prescription Business Draw Cautious View from Jefferies

GoodRx Holdings Inc. (NASDAQ:GDRX) is one of the best stocks under $3 to invest in, although one firm had recently become neutral on the stock. On January 22, analysts at Jefferies lowered their rating on GoodRx Holdings Inc. (NASDAQ:GDRX) to Hold from Buy and cut the price target to $2.75 from $5.25. According to Jefferies, the Rite Aid bankruptcy and the subsequent mass closures of 800 pharmacy locations from June to July 2025 have adversely affected GoodRx’s drug prescription business to the tune of a 14% year-over-year decline in monthly active consumers and a 9% drop in prescription revenues.

Jefferies expects GoodRx Holdings Inc. (NASDAQ:GDRX)’s prescription revenues to remain flat year-over-year as it continues to face challenges in its prescription discount segment, which represents about 69% of the company’s expected revenue. The analysts also project that overall revenue and EBITDA growth will remain muted, making GoodRx’s valuation multiple stagnant at least in the short run.

GoodRx Holdings Inc. (NASDAQ:GDRX) is a digital healthcare platform that offers consumers free access to transparent and lower prices for branded and generic medications.

https://finviz.com/news/302998/headwinds-in-goodrxs-gdrx-drug-prescription-business-draw-cautious-view-from-jefferies

Trump order modifying duties to address threats to US by government of Russian Federation

 By the authority vested in me as President by the Constitution and the laws of the United States of America, including the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (IEEPA), the National Emergencies Act (50 U.S.C. 1601 et seq.), section 604 of the Trade Act of 1974, as amended (19 U.S.C. 2483), and section 301 of title 3, United States Code, I hereby determine and order:

Section 1.  Background.  Executive Order 12957 of March 15, 1995 (Prohibiting Certain Transactions With Respect to the Development of Iranian Petroleum Resources), found that the actions and policies of the Government of Iran constitute an unusual and extraordinary threat to the national security, foreign policy, and economy of the United States and declared a national emergency to deal with that threat.  Numerous subsequent Executive Orders — including Executive Order 13059 of August 19, 1997 (Prohibiting Certain Transactions With Respect to Iran); Executive Order 13590 of November 20, 2011 (Authorizing the Imposition of Certain Sanctions With Respect to the Provision of Goods, Services, Technology, or Support for Iran’s Energy and Petrochemical Sectors); Executive Order 13622 of July 30, 2012 (Authorizing Additional Sanctions With Respect to Iran); Executive Order 13902 of January 10, 2020 (Imposing Sanctions With Respect to Additional Sectors of Iran); and others — have further described the threat posed by the Government of Iran and taken additional action to deal with the national emergency declared in Executive Order 12957.  For example, Executive Order 13553 of September 28, 2010 (Blocking Property of Certain Persons With Respect to Serious Human Rights Abuses by the Government of Iran and Taking Certain Other Actions), took additional steps with respect to the national emergency declared in Executive Order 12957, including authorizing the blocking of property to address serious human rights abuses against persons in Iran.  Executive Order 13846 of August 6, 2018 (Reimposing Certain Sanctions With Respect to Iran), also took additional steps with respect to the national emergency declared in Executive Order 12957, including imposing sanctions to advance the goal of applying financial pressure on the Iranian regime in pursuit of a comprehensive and lasting solution to the full range of the threats posed by the Government of Iran.

I have received additional information from various senior officials on, among other things, the actions and policies of the Government of Iran, including the circumstances related to the national emergency declared in Executive Order 12957 and expanded on in subsequent orders.  After considering this additional information, among other things, I find that the national emergency declared in Executive Order 12957 and further described in subsequent orders continues and that the actions and policies of the Government of Iran continue to pose an unusual and extraordinary threat, which has its source in whole or substantial part outside the United States, to the national security, foreign policy, and economy of the United States.

To deal with the national emergency described in Executive Order 12957 and subsequent orders, I determine that it is necessary and appropriate to impose an additional ad valorem duty on imports of articles that are products of foreign countries that directly or indirectly purchase, import, or otherwise acquire any goods or services from Iran.  In my judgment, the tariff regime, as described below, in addition to maintaining the other measures taken to address the national emergency described in Executive Order 12957 and subsequent orders, will more effectively deal with the national emergency described in those orders.

Sec. 2.  Imposition of Tariffs.  (a)  Beginning on the effective date of this order, an additional ad valorem rate of duty — for example, 25 percent — may be imposed on goods imported into the United States that are products of any country that directly or indirectly purchases, imports, or otherwise acquires any goods or services from Iran, in accordance with subsections (b) and (c) of this section.  

(b)(i)  The Secretary of Commerce, in consultation with the Secretary of State and any senior official the Secretary of Commerce deems appropriate, shall determine whether, after the effective date of this order, a foreign country directly or indirectly purchases, imports, or otherwise acquires any goods or services from Iran.  After the Secretary of Commerce finds that a foreign country directly or indirectly purchases, imports, or otherwise acquires any goods or services from Iran, the Secretary of Commerce shall inform the Secretary of State of his finding, including any information relevant to that finding. 

(ii)  The Secretary of Commerce may issue rules, regulations, and guidance necessary or appropriate to implement this order.  The Secretary of Commerce may also make any other determinations or take any other actions necessary or appropriate to implement this order.

(c)(i)  After the Secretary of Commerce makes an affirmative finding pursuant to subsection (b)(i) of this section and informs the Secretary of State of his finding, the Secretary of State, in consultation with the Secretary of the Treasury, the Secretary of Commerce, the Secretary of Homeland Security, and the United States Trade Representative, shall determine whether and to what extent an additional ad valorem rate of duty should be imposed on goods that are products of the foreign country found to directly or indirectly purchase, import, or otherwise acquire goods or services from Iran.  

(ii)   If the Secretary of State determines that an additional ad valorem rate of duty should be imposed on goods that are products of the country found to directly or indirectly purchase, import, or otherwise acquire goods or services from Iran, the Secretary of State shall inform me of his recommendation, and the Secretary of Commerce shall inform me of his finding related to that recommendation.  I will then consider the recommendation and finding, among other relevant things, in determining whether and to what extent to impose an additional ad valorem rate of duty on goods that are products of the country in question. 

(iii)  The Secretary of State may issue rules, regulations, and guidance necessary or appropriate to implement this order.  The Secretary of State may also make any other determinations or take any other actions necessary or appropriate to implement this order.

Sec. 3.  Modification Authority.  (a)  To ensure that the national emergency described in section 1 of this order is dealt with, I may modify this order, including in light of additional information, recommendations from senior officials, or changed circumstances.

(b)  Should a foreign country retaliate against the United States in response to this order or any action taken pursuant to this order, I may modify this order or actions taken pursuant to this order to ensure the efficacy of this order and the actions taken pursuant to this order to deal with the national emergency described in section 1 of this order. 

(c)  Should the Government of Iran or a foreign country affected by this order take significant steps to address the national emergency described in section 1 of this order and align sufficiently with the United States on national security, foreign policy, and economic matters, I may modify this order.

Sec. 4.  Monitoring and Recommendations.  (a)  The Secretary of State, in consultation with any senior official the Secretary of State deems appropriate, shall monitor the circumstances involving the national emergency described in section 1 of this order.  The Secretary of State shall inform me of any circumstance that, in his opinion, might indicate the need for further Presidential action.

(b)  The Secretary of State, in consultation with the Secretary of the Treasury, the Secretary of Commerce, the Secretary of Homeland Security, the United States Trade Representative, and any other senior official the Secretary of State deems appropriate, shall recommend to me additional action, if necessary, if the actions in this order or taken pursuant to this order are not effective in dealing with the national emergency described in section 1 of this order.

(c)  The Secretary of Commerce shall monitor whether a foreign country directly or indirectly purchases, imports, or otherwise acquires any goods or services from Iran.  The Secretary of Commerce shall continue such monitoring after a foreign country has been found to do so.

Sec. 5.  Delegation.  Consistent with applicable law, the Secretary of State, the Secretary of Commerce, and the United States Trade Representative are directed and authorized to take all actions necessary to implement and effectuate this order — including through temporary suspension or amendment of regulations or through notices in the Federal Register and by adopting rules, regulations, or guidance — and to employ all powers granted to the President, including by IEEPA, as may be necessary to implement this order.  The head of each executive department and agency (agency) is authorized to and shall take all appropriate measures within the agency’s authority to implement this order.  The head of each agency may, consistent with applicable law, including section 301 of title 3, United States Code, redelegate the authority to take such appropriate measures within the agency.

Sec. 6.  Definitions.  For the purposes of this order:

(a)  The term “goods or services from Iran” shall be construed consistent with 31 C.F.R. 560.306, and the term shall include only goods or services for which United States persons are prohibited from trading in with respect to Iran.

(b)  The term “indirectly” includes purchases, imports, or other acquisitions of Iranian goods and services through intermediaries or third countries where the origin of the good or service can reasonably be traced to Iran, as determined by the Secretary of Commerce.

(c)  The term “Iran” means the Islamic Republic of Iran, its territory, and any other territory or marine area, including the exclusive economic zone and continental shelf, over which the Government of Iran claims sovereignty, sovereign rights, or jurisdiction, provided that the Government of Iran exercises partial or total de facto control over the area or derives a benefit from economic activity in the area pursuant to international arrangements.

(d)  The term “Government of Iran” includes the Government of the Islamic Republic of Iran, any political subdivision, agency, or instrumentality thereof, including the Central Bank of Iran and the Islamic Revolutionary Guard Corps, and any person owned or controlled by, or acting for or on behalf of, the Government of Iran.

Sec. 7.  Effective Date.  This order is effective at 12:01 a.m. eastern standard time on February 7, 2026.

Sec. 8.  Severability.  If any provision of this order or the application of any provision of this order to any individual or circumstance is held to be invalid, the remainder of this order and the application of its provisions to any other individuals or circumstances shall not be affected.  If the action in this order or any action taken pursuant to this order is held invalid, the other actions imposed to deal with the national emergencies declared with respect to the Government of Iran shall not be affected and shall remain in effect.

Sec. 9.  General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect:

(i)   the authority granted by law to an executive department or agency, or the head thereof; or

(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

(d)  The costs for publication of this order shall be borne by the Department of Commerce.

                               DONALD J. TRUMP

THE WHITE HOUSE,

    February 6, 2026.

https://www.whitehouse.gov/presidential-actions/2026/02/modifying-duties-to-address-threats-to-the-united-states-by-the-government-of-the-russian-federation/