WASHINGTON, D.C.: President Donald Trump is preparing to extend his aggressive tariff strategy to the pharmaceutical industry, setting the stage for potential disruptions in drug supplies and higher costs for American patients.

For decades, most imported medicines have been duty-free in the United States. However, under a new trade deal with Europe, some drugs will face a 15 percent tariff, and Trump has threatened to impose duties of up to 200 percent on pharmaceuticals made elsewhere.

"Shock and awe'' is how Maytee Pereira of PwC described the potential impact on drugmakers. "This is an industry that's going from zero (tariffs) to the potential of 200 percent."

The White House insists the plan is part of a broader effort to reduce reliance on foreign supply chains and bring manufacturing back to the U.S. However, health economists warn that the policy could raise prescription drug prices, squeeze generic manufacturers out of the market, and create dangerous shortages.

"A tariff would hurt consumers most of all, as they would feel the inflationary effect ... directly when paying for prescriptions at the pharmacy and indirectly through higher insurance premiums," said Diederik Stadig, a healthcare economist at ING. He added that lower-income households and older Americans would feel the sharpest impact.

Trump has promised to delay the new tariffs for up to 18 months, giving drugmakers time to stockpile supplies and possibly shift production to U.S. facilities. Analysts say many companies already have six to 18 months of inventory in place.

Some observers believe Trump will ultimately settle for lower duties, closer to 25 percent, though even that would push prices higher. Stadig estimates a 25 percent levy could raise drug costs by 10 percent to 14 percent once stockpiles are exhausted.

Drugmakers have been steadily moving production overseas for decades, taking advantage of lower costs in countries like China and India. That dependence became especially clear during the COVID-19 pandemic, when global shortages exposed the risks of foreign reliance.

Trump's plan aims to reverse that trend. Roche, Johnson & Johnson, and other companies have announced tens of billions of dollars in new U.S. investments, though building new factories can take years. Even then, most drugs still rely on imported ingredients: nearly all antibiotics and antivirals contain at least one component manufactured abroad.

While large brand-name companies may absorb costs, generic drugmakers face tougher choices. Some could pull out of the U.S. market, threatening the supply of the low-cost medications that account for over 90 percent of American prescriptions.

"In an ideal world, we would be making everything that's important only in the U.S.," said Marta Wosińska of the Brookings Institution. "But it costs a lot of money ... If we want to reverse this, we would really have to redesign our system. How much are we willing to spend?"