HONG KONG/NEW YORK — As U.S. President Donald Trump escalates threats to impose tariffs on pharmaceutical imports, new attention is being drawn to America’s overwhelming dependence on China for vital drug ingredients. A staggering 80% of the raw materials used to produce amoxicillin, one of the most commonly prescribed antibiotics in the U.S., come from China. Even more alarming, the U.S. has just one domestic manufacturer of this essential medication.
The pharmaceutical trade imbalance is striking. In 2024, 96% of hydrocortisone imports, 90% of ibuprofen, and 73% of acetaminophen coming into the U.S. originated in China. Experts warn that any disruption—whether economic or political—could trigger severe shortages and drive up prices, particularly for generics, which make up 90% of all U.S. prescriptions.
Trump’s proposed tariffs aim to bring drug production back to U.S. soil, citing national security concerns. However, critics argue the move may do more harm than good. Generics operate on razor-thin margins, and new tariffs could force many producers out of the American market altogether, deepening existing shortages and raising health care costs for millions.
China’s control over the global pharmaceutical supply chain, particularly active pharmaceutical ingredients (APIs), stems from decades of industrial policy, government subsidies, and fewer environmental constraints. The country accounts for 32% of global API filings to the U.S. FDA, with India trailing at 50%—but even India relies heavily on Chinese raw materials, importing 70% of its APIs from China.
Despite the strategic risks, the U.S. has been slow to diversify its pharmaceutical supply chain. A 2021 attempt by entrepreneur Rick Jackson to revive domestic amoxicillin production illustrates the challenge: even with a Tennessee facility operational, the U.S. remains tied to Chinese imports for key materials.
The COVID-19 pandemic and recent U.S.-China tensions have reinforced Beijing’s leverage, with Chinese state policy explicitly encouraging consolidation of global supply chain dominance as a form of economic deterrence. While some companies, like AstraZeneca and Johnson & Johnson, are expanding U.S. operations, most focus on patented, high-margin drugs—not low-cost generics.
Economists warn that tariffs could backfire, increasing drug costs without solving the supply issue. A 25% tariff on imports could cost U.S. consumers an additional $50 billion annually and raise drug prices by nearly 13%, according to recent industry research. Some generic cancer treatments could rise by as much as $10,000 per cycle.
Experts agree that incentives—not tariffs—are needed to build a more resilient pharmaceutical ecosystem in North America. The stakes are high: a drug shortage doesn’t just inconvenience—it can be fatal.
“People’s lives depend on these medicines,” said Ronald Piervincenzi, CEO of the United States Pharmacopeia. “You can live without ketchup on the shelf. You can’t live without your cancer medication.”