President Donald Trump’s announcement of 100% tariffs on foreign-made brand-name prescription drugs has raised concern among patients, doctors, and insurers alike. While the policy is aimed at boosting U.S. drug manufacturing, many experts say it leaves major questions unanswered about how it would work in practice — and how it could affect patients.
In a post on Truth Social, Trump said the tariffs will take effect October 1, 2025, unless a pharmaceutical company is already “building” a U.S. manufacturing facility. He defined that as breaking ground or being under construction. Drugs made at or tied to such facilities would be exempt.
Here are five major questions experts are asking about the plan:
1. Which drugs would be affected?
Trump did not clarify whether companies with existing U.S. plants would see all their products exempted, or only the ones made at those facilities.
Some major drugmakers, including Novo Nordisk (maker of Wegovy) and Eli Lilly (maker of Zepbound and Mounjaro), have announced plans to expand U.S. manufacturing. AstraZeneca, which produces the asthma drug Symbicort, has also pledged billions in new U.S. investment.
But many widely used brand-name medications are still manufactured overseas. Botox and Merck’s cancer drug Keytruda are made largely in Ireland. Other cancer therapies and vaccines are produced in India and China.
That leaves uncertainty over how many products would actually face tariffs.
2. Will patients pay higher prices?
Brand-name drugs make up only about 10% of prescriptions filled in the U.S., but they account for the vast majority of drug spending. Generics, which are not targeted by the tariffs, dominate prescriptions.
Whether patients see higher costs depends on how many exemptions are granted and whether companies choose to pass along added costs.
“Ultimately, tariffs are taxes on patients,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School. “To the extent that drug companies see increases in cost, they will pass those costs on.”
Some patients may not notice much change, since many brand-name drugs are already priced at premium levels in the U.S. Others could see sharp increases, especially for specialty medications.
3. Will insurance companies absorb the costs?
Health insurers and pharmacy benefit managers might try to negotiate discounts or absorb some expenses, but experts say it’s more likely they’ll shift costs to patients in the form of higher copays or deductibles.
Because Medicare, Medicaid, and the VA are the country’s largest drug purchasers, government programs could also face significant financial pressure. That may affect coverage decisions or lead to higher taxpayer spending.
4. Could tariffs lead to more U.S. drug manufacturing?
The White House argues that tariffs will push companies to expand domestic production. But experts caution that building a plant is a multiyear, multibillion-dollar process, and most projects wouldn’t be completed until long after Trump leaves office.
“It can take between two to five years to build a facility and secure regulatory approval,” said Rena Conti, a professor at Boston University’s Questrom School of Business. Even updating an existing facility can take up to three years.
Industry leaders warn that tariffs could backfire. “Every dollar spent on tariffs is a dollar that cannot be invested in American manufacturing or future treatments,” said Alex Schriver, a spokesperson for the Pharmaceutical Research and Manufacturers of America.
5. Could this cause drug shortages?
Experts say shortages are unlikely for major brand-name drugs, given the large profit margins pharmaceutical companies already maintain. But smaller companies that produce niche or specialty drugs could struggle.
If tariffs were extended beyond brand-name drugs to generics, the risk of shortages would rise sharply. Generic drugs are typically sold close to their cost of production, leaving little room for added expenses. Companies might stop making them rather than absorb new costs.
Bottom line
Trump’s proposal is designed to encourage pharmaceutical companies to manufacture more drugs in the U.S., but it leaves major questions unresolved. Patients, insurers, and government programs may all face higher costs, and experts are skeptical the tariffs will meaningfully increase domestic production anytime soon.
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