US President Donald Trump’s new executive order introducing a “Most Favoured Nation” (MFN) pricing policy aims to align US drug prices with the lowest globally, potentially cutting US drug costs by 30–80%. However, this could pressure India and other developing markets to raise drug prices, as global pharma companies shift pricing strategies. India’s low-cost generics industry, already under scrutiny over IP rights, may face increased demands to adopt stricter patent norms. Experts warn this move could shift the battleground from legal to trade negotiations, urging India to defend its TRIPS-compliant regime and public health safeguards against TRIPS-plus provisions in trade agreements.