Trump Wants Pharmaceutical Tariffs Soon — Here’s Which Drugs Could Disappear From Hospitals First

We use pharmaceutical drugs every day to heal infections, treat cancers and relieve pain. But if President Donald Trump has his way, these largely foreign-made drugs would be targeted with tariffs, potentially causing unexpected shortages and making your doctor’s visit look much different in the future, experts say.

Erin Fox, a drug shortages expert at University of Utah Health, said a major tariff could cause companies to discontinue production of low-cost, low-margin drugs like the ingredients in epidurals, as one example. She said patients could end up receiving alternative medicines because the hospital has a shortage of certain pharmaceutical drugs.

“Maybe everybody doesn’t get an epidural,” she said. “We may be going back in time there.“

So far, pharmaceutical drugs have been one of the few exceptions from Trump’s ongoing trade war against the world. They were left out of Trump’s “Liberation Day” announcement in April to impose exorbitant levies on imports from foreign nations. But this reprieve may not be for much longer.

Since taking office again, Trump has repeatedly said that he believes using tariffs on pharmaceuticals can pressure drugmakers to move their manufacturing back to the U.S.

“We’re going to be announcing very shortly a major tariff on pharmaceuticals,” Trump said in April at the National Republican Congressional Committee dinner, and earlier this year, he said he would impose a tariff of at least 25% on pharmaceuticals.

In April, the Department of Commerce also announced an investigation into the national security implications of pharmaceutical imports, which could set the stage for justifying tariffs on pharmaceutical drugs as a solution.

“The reason why it’s particularly relevant is that the [Trump] administration has used it to also do steel tariffs,” said Marta E. Wosińska, a senior fellow on health policy at the Brookings Institution.

It is not yet clear when that national security investigation will end, and if and how tariffs on pharmaceuticals will be implemented. But U.S. pharmacists are already stockpiling the most common drugs for that possibility.

Because the supply chain for medications is not transparent, Fox said, it’s not exactly clear which drugs would be impacted by tariffs the most. But if an extreme pharmaceutical tariff does happen, here’s which types of drugs could be most at risk of disappearing for people in need.

Most over-the-counter pain medication you get in the U.S. comes from China. You wouldn’t notice drug disappearances right away because of stockpiles. If tariffs went into effect on June 1, Fox said you could realistically notice some shortages by Halloween and Christmas.

“The first thing that would happen is you would just have way fewer choices,” Fox said. Right now, if you go to a drugstore, you can buy ibuprofen in multiple forms, as a liquid or as a tablet from different store brands. “I think it’s very realistic that that would shrink,” she said.

Most prescriptions in the U.S. are for generic drugs, and many active pharmaceutical ingredients (APIs) in those drugs are sourced from overseas.

Generic injectable drugs that hospitals use every day, like lidocaine and morphine, are basic drugs that are cheap to produce, and they would be vulnerable to getting discontinued under a major tariff because companies would pivot to making more profitable drugs, Fox said.

“What my fear is and what I anticipate is that we will see … six to eight months out, we’re going to see companies start to discontinue these very basic but very essential drugs, because they just can’t absorb those added costs,” Fox said.

Generic drugs have low profit margins and “unless they can increase the price, the drug is going to be completely unprofitable, and they’ll want to get out of the U.S. market,” Wosińska said.

There are “zero requirements” from the government to force any company to make any drug, no matter how life-saving it is, Fox said.

“Cancer drugs, I would say, are the ones that I worry about the most” of getting impacted by major pharmaceutical tariffs, Wosińska said, noting that they could lead to hospital shortages. “You get admitted to a hospital, go for your cancer treatment, and the doctor tells you, ‘Sorry, we don’t have that,’” Wosińska said as one scenario.

These drugs already face supply issues. In 2023, there were shortages of Cisplatin, a critical chemotherapy drug, driven by manufacturing quality problems in an Indian facility. The facility had 50% of the market share for the drug, highlighting how one problem in the supply chain can cause ripple effects.

That 2023 supply disruption was due to quality issues. But if Trump enacted widespread pharmaceutical tariffs, this kind of shortage would be due to money.

Most cancer drugs have to be administered by a physician, and many are covered under the U.S. government’s “340B” safety-net program, which allows qualified hospitals and other health care providers to buy certain outpatient medications at steeply discounted prices from manufacturers. This program is meant to increase access to outpatient medications.

But it could also make cancer drugs unprofitable for manufacturers to continue making under 20-25% tariffs. “Manufacturers in this scenario, if they sell to a ‘340B’ hospital, would have to eat 90% of the tariff,” Wosińska said.

“If their margins are really low, they’re just going to say, ‘We’re out of here,‘” she continued. “Cancer drugs in particular have really high exposure to ‘340B’ ― it could be more than half their market.” The higher the tariffs are, the more likely this kind of market exit will happen, she said.

Not in the near future, Fox said, noting it takes at least three years to build a medication factory in the U.S. because they involve complicated Food and Drug Administration regulations and inspections.

There have been tariff success stories, though. Hospital-administered drugs usually come in a vial that you need a syringe to use, and most of those syringes are made in China. Wosińska cited how tariffs on Chinese syringes pushed U.S. facilities to reopen during COVID and have ensured we have a domestic supply of a critical product. But that worked because factories already had the capacity to produce that product.

Another way that tariffs aren’t all bad: Wosińska said a China-only tariff could be helpful at incentivizing other nations like India to stop relying on Chinese active pharmaceutical ingredients. That would, in turn, helps the U.S. since it buys a lot of products from India. But a widespread tariff that includes India would exacerbate the risk of generic drug shortages and incentivize India to purchase from cheaper Chinese sources, Wosińska has argued.

For now, Trump continues to defend his tariff trade policy as a “legendary” achievement. If he ends up setting a 25% tariff on all foreign-made pharmaceuticals, it will certainly be memorable. But losing access to preferred or necessary medical treatments because of drug shortages is not a future we would want to remember.

“We don’t want to see products discontinued that we need, and it could be a reality,” Fox said. “This winter, when you have a cold, that medicine that you’re looking for, it may not be on the shelf.”