President Donald Trump announced a new set of agreements Monday with international pharmaceutical companies and smaller biotechnology firms, expanding his administration’s campaign to reduce healthcare costs for Americans.

The latest agreements involve nine companies, including Astellas, BeOne Medicines, CSL, BridgeBIO, Sun Pharmaceutical, Teva and UCB.

According to Trump, the companies have agreed to provide medications to state Medicaid programs at most-favored-nation prices. During an Oval Office event attended by executives from the companies, Trump characterized the arrangements as “a tremendous discount, which should bring down the cost of your medical care by tremendous amounts.”

Americans continue to pay substantially more for prescription drugs than patients in other developed countries, in many cases nearly three times as much. Trump has been pushing pharmaceutical manufacturers to bring U.S. prices closer to the amounts paid for the same medicines abroad.

The newly announced agreements expand on deals the administration reached beginning last year with 17 of the world’s largest pharmaceutical companies, including Pfizer, Eli Lilly and Amgen. Under those arrangements, drugmakers agreed to reduce prices toward levels paid in other developed nations under the administration’s “most-favored-nation” pricing approach.

Those earlier agreements also included reductions for certain federal healthcare programs and provisions allowing some medicines to be sold directly to consumers through a Trump-branded website. In exchange, participating pharmaceutical companies received tariff relief.

Smaller drugmakers have been slower to join

Small and midsize pharmaceutical companies have been more reluctant to participate in the administration’s drug-pricing initiative, according to previous Reuters reporting.

A Reuters report published in June found that Astellas was the only company among that group to have publicly confirmed that it had applied for the Medicaid pricing program at the time. Executives at companies including Ionis Pharmaceuticals had indicated that they saw limited financial incentives for participating.

The financial impact of the new agreements remains uncertain. It is not yet known how much the arrangements will ultimately save either the government or patients. Medicaid already receives substantial discounts from drug manufacturers under existing federal law, while most Medicaid beneficiaries have relatively low out-of-pocket prescription costs.

The White House has staged several prominent events with pharmaceutical executives this year to showcase its efforts to lower healthcare expenses. The campaign comes as the administration seeks to emphasize affordability ahead of the midterm elections, which will determine control of Congress.

The administration has estimated that its broader drug-pricing initiative including the earlier agreements with major pharmaceutical manufacturers could reduce federal and state spending by $64.3 billion over the next decade. That projection, however, remains speculative.