Big Pharma has a big headache: Donald Trump. Lately drugmakers have had to contend with the American president’s pronouncements on everything from vaccines to paracetamol. In the coming days the pain is set to intensify. Intent on lowering prices, Mr Trump has given leading pharma firms until September 29th to comply with an executive order to peg their prices to the lowest charged in other rich countries—a rule he calls “most favoured nation” (MFN) pricing. If they do not, he thundered, they will face “every tool in our arsenal” against “abusive drug pricing”.
At the same time, the president wants to encourage homegrown manufacturing. He plans to impose a 100% tariff on branded drugs from October 1st, unless their makers are building factories in America. His administration is also pondering additional duties under a law allowing imports to be restricted on national-security grounds.
As is often the case, the Trumpian diagnosis contains a kernel of truth. Drug prices are indeed higher in America than elsewhere in the rich world. But the president’s two-point prescription upends a model that has long underpinned the highly globalised pharma industry, which could have unintended effects. It could leave Americans with fewer medicines but not cheaper ones, while in other countries drugs could be fewer and dearer. David Ricks of Eli Lilly, the world’s most valuable drugmaker, has warned that MFN pricing risks “the worst of two worlds”, importing Europe’s sluggish innovation while keeping American prices high.
America’s drug prices were more than three times the average in other rich countries in 2022. As a consequence, it coughs up around 70% of global pharmaceutical profits from about half of global sales. This is partly because of how the market is organised https://t.co/eyJHSfPEB3
— The Economist (@TheEconomist) September 29, 2025
