To achieve Most Favored Nation (MFN) drug pricing, the administration paired HHS negotiators with the Commerce Secretary. While one team negotiated terms, the Commerce Secretary acted as the "hammer," holding a credible threat of crippling tariffs over pharmaceutical companies that primarily manufacture overseas. This forced compliance.
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Initial panic over the MFN drug pricing scheme was based on pegging U.S. prices to the lowest in the industrialized world. The actual proposal is far less drastic, targeting the second-lowest price among a small cohort of high-income nations (G7 plus Denmark and Switzerland), a significantly less onerous benchmark.
China holds a choke point on the global pharmaceutical supply chain, being the sole source for key ingredients in hundreds of US medicines. This leverage could be used to restrict supply, creating shortages and price hikes, opening a new, sensitive front in geopolitical tensions.
Instead of immediately passing tariff costs to consumers, US corporations are initially absorbing the shock. They are mitigating the impact by reducing labor costs and accepting lower profitability, which explains the lag between tariff implementation and broad consumer inflation.
The biopharma outsourcing sector has proven surprisingly resilient to international tariffs. Instead of absorbing costs, well-funded European companies are bypassing tariffs altogether by investing in and building new production facilities directly on U.S. soil, effectively onshoring their manufacturing.
While MFN pricing is seen as a major threat, it could have an unexpected positive effect. It would force companies launching new drugs to establish a GDP-adjusted global price from the start, ending the current system where the U.S. effectively subsidizes lower prices elsewhere.
Major pharmaceutical companies are now willing to deploy the "nuclear option" of pulling planned R&D investments to express displeasure with national drug pricing policies. This tactic, seen in the UK, represents a direct and aggressive strategy to pressure governments into accepting higher prices for innovative medicines.
Unlike previous administrations that used trade policy for domestic economic goals, Trump's approach is distinguished by his willingness to wield tariffs as a broad geopolitical weapon against allies and adversaries alike, from Canada to India.
A new US-UK agreement exempts UK pharmaceuticals from tariffs in exchange for the UK's National Health Service (NHS) paying 25% more for new drugs. This deal effectively uses the UK's drug-costing watchdog, NICE, as a bargaining chip, undermining its authority to secure a trade concession from the US.
Contrary to popular belief, Trump's trade strategy isn't protectionism. He uses reciprocity, leverage, and executive flexibility to force other countries to lower their own trade barriers, ultimately aiming for a world with freer trade for the U.S.
Contrary to popular belief, tariffs can be disinflationary by forcing foreign producers to absorb costs to maintain volume. They also function as a powerful national security tool, compelling countries to negotiate on non-trade issues like fentanyl trafficking by threatening their core economic models.
