One hundred percent. That is the tariff the Trump administration will impose on imported patented pharmaceuticals and their active ingredients — a doubling of the landed cost of branded medicines entering the United States from most of the world.

The proclamation, signed April 2 under Section 232 of the Trade Expansion Act of 1962, establishes the most aggressive trade action against medicines in modern US history. It takes effect July 31 for large companies and September 29 for smaller ones. The stated rationale is national security: a Commerce Department investigation found that the US imports 53 percent of its patented pharmaceuticals and produces just 15 percent of its patented active pharmaceutical ingredients domestically, according to FDA data cited in the proclamation.

But the headline number barely tells half the story. The actual tariff any given company pays depends on a web of exemptions, trade deals, and — most importantly — whether that company has signed a pricing agreement with the Trump administration.

The Exemption Architecture

The 100 percent rate is the default. Everything else is a carve-out.

Companies that sign both a Most Favored Nation pricing agreement with the Department of Health and Human Services and an onshoring agreement with Commerce face zero tariffs through January 20, 2029. Companies that commit only to onshoring get 20 percent — which rises to 100 percent after four years. Products from the European Union, Japan, South Korea, and Switzerland face a flat 15 percent under existing trade deals. Generic drugs and biosimilars are exempt entirely, for now.

And then there is the United Kingdom. British pharmaceutical exports to the US will face an initial 10 percent tariff, reducing to zero under a bilateral agreement reached in principle as of December 2025. The terms of that deal have not been published.

Public Citizen, the advocacy group, was blunt. “The administration is exempting many drugmakers from tariffs in exchange for secretive arrangements that allow Trump to claim specious victories on manufacturing and high drug prices,” said Peter Maybarduk, the group’s Access to Medicines director.

Sixteen Companies Said Yes. One Didn’t.

The White House says 16 of the 17 large pharmaceutical companies that received demand letters from Trump last July have now signed MFN pricing agreements. The deals share a common shape: discounted prices through a new government direct-to-consumer platform called TrumpRx.gov, plus pledges of US manufacturing investment.

The companies include Pfizer, Johnson & Johnson, AstraZeneca, Novo Nordisk, Eli Lilly, AbbVie, Bristol Myers Squibb, Gilead, Merck, Roche, Novartis, Amgen, Sanofi, GSK, Boehringer Ingelheim, and EMD Serono, the US unit of Germany’s Merck KGaA, according to Reuters.

The discounts are substantial, at least on paper. Novo Nordisk will sell Ozempic and Wegovy — currently priced at roughly $1,000 and $1,350 per month — for $350 through TrumpRx. Bristol Myers Squibb said it would provide its blood-thinner Eliquis to Medicaid for free and donate more than seven tons of active pharmaceutical ingredient.

The sole holdout is Regeneron, which said in April it anticipates announcing a deal “in the near future.” Until it does, its imports face the full 100 percent.

What the Deals Actually Cost

The White House claims the tariffs have already spurred approximately $400 billion in new investment commitments from pharmaceutical companies during Trump’s current term.

That figure deserves scrutiny. Public Citizen noted that “many manufacturing commitments claimed under the deals were part of previously-planned projects.” Disentangling what was already in the pipeline from what was tariff-driven is difficult without independent verification.

The specific terms of most pricing deals remain undisclosed. Johnson & Johnson reached an agreement in January, but “specific terms were not disclosed, including details on revised drug prices or which medicines are covered,” per Reuters. The TrumpRx platform covers a limited number of drugs so far, many of which have generic alternatives available at lower cost elsewhere, CNN reported.

The Missing Report and the Midsized Problem

The Commerce Department launched its Section 232 investigation into pharmaceutical imports a year ago. The proclamation says the investigation found that imports threaten national security. But the underlying report has not been made public.

Public Citizen has filed suit against HHS and Commerce for disclosure of the tariff-exemption agreements.

Then there is the question of who gets squeezed between the companies that cut deals and the generic players left alone. The newly formed Midsized Biotech Alliance of America argues the policy “creates an unfair two-tiered system” that leaves smaller innovators reliant on “a handful of patented medicines to shoulder the burden.” Midsize biotechs lack the capital to build US manufacturing or the product portfolios to spread pricing concessions across dozens of drugs. For them, the 100 percent tariff is an existential threat.

Who Pays at the Pharmacy Counter

A senior administration official told reporters that the tariffs would not raise costs for consumers. That claim rests on the assumption that companies will absorb tariff costs rather than pass them through — an assumption that conflicts with how tariffs have historically functioned. A 100 percent duty on imported branded drugs enters the supply chain somewhere. The patients least able to negotiate — the uninsured, those on fixed incomes, those whose drugs have no generic alternative — are the ones least positioned to absorb the difference.

For companies that signed MFN deals, the tariff exemption runs through January 20, 2029 — conveniently, the end of Trump’s current term. The onshoring-only pathway jumps from 20 percent to 100 percent in April 2030. The generic exemption will be “reassessed in one year.”

The structure is less a permanent industrial policy than a series of renewable leverage points. The administration retains authority to increase tariff rates unilaterally, and the proclamation authorizes retroactive tariff increases on past imports.

What Happens Next

The 120-day clock before large-company tariffs take effect gives drugmakers until late July to negotiate. More deals are likely. Midsize companies will scramble for exemptions or face the full rate.

Meanwhile, the UK deal — the most favorable tariff treatment of any country — remains unpublished. Public Citizen’s characterization of the arrangement as one that will “force the country to increase spending on brandname medicines” suggests Britain may have agreed to raise what it pays for US drugs, effectively exporting higher prices to British patients in exchange for tariff-free access to the American market.

The global pharmaceutical supply chain is about to reroute. Whether it reroutes toward genuine US manufacturing resilience or simply toward companies skilled at negotiating opaque deals with the current administration is the question that will determine what this policy actually costs — and who pays it.

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