As with all things DJT, the devil is in the detail AND things often shake out differently over time. Tariffs are a case in point - I think everyone thought it would be Armageddon but the market has effectively recovered its losses since independence day and trade deals have been struck that are more favourable to the USA.
I am certainly not defending him but you could make the argument that it's a smart move by him.
His natural inclination/PoV is that American's are getting screwed and paying more than their fair share across the board - for the Ukraine war, for NATO, in trade terms with Tariffs, for membership of WHO and other peak bodies etc. His base (and more than 50% of the voters in the last election) supported that view.
How do you appeal to their instincts, satisfy your own ideological standpoint and keep powerful groups like big Pharma happy? You sign an EO that looks great to the base, while essentially giving Pharma the ability/permission to raise prices ex-USA, so that their margins are not severely impacted. Everyone is happy.
The base is placated because he is fighting for them. The American consumer broadly is convinced that they are getting a good outcome. He looks like a good deal maker, he puts his people first and he is providing an economic boon, which materialises when American Pharma companies jack up their prices ex-USA and bring in "wonderful", "Huge" profits.
I agree with others, that the PBM is a huge issue in the USA and I think that is part 2 of the plan. Get this across the line and then go after the middle-man which would allow a genuine reduction in US prices and then he wins again.
Not a bad way to keep lots of different parties happy.
Not good for us and other countries. In fairness though, he is not elected to be our President
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