Trump's 100% drug tariffs will hit patented medicines unless companies secure deals, with $400bn in US manufacturing pledges already secured. The administration aims to reduce reliance on foreign drugmakers by incentivizing domestic production through tiered tariffs: 20% for new US facilities, dropping to zero with pricing agreements.

Deals require firms to sell medicines to Medicaid at overseas-market prices and commit to US manufacturing by January 2029. UK-NHS agreements exemplify this approach, with Britain paying higher drug prices in exchange for zero tariffs on UK-made pharmaceuticals for three years. Small companies face longer negotiation timelines (180 days vs. 120 days for large firms).

While major players like Pfizer and Moderna have secured exemptions, smaller firms risk higher costs. Experts warn the policy's success hinges on exemption eligibility and whether pricing deals can offset manufacturing expenses. Tariffs expire post-Trump's term, adding urgency to negotiations.

The move mirrors broader trade strategies targeting metals, with steel and aluminum tariffs now exempting low-metal-content products. By leveraging tariffs as bargaining chips, the US seeks to reshape global pharma supply chains.