| The Trump administration launched a probe Monday that could open the door to tariffs on pharmaceutical imports. Under this 232 investigation, the Commerce Department has as long as 270 days to determine whether the foreign production of drugs is a threat to national security, though it could release the findings much more quickly. China, India and the EU are major exporters of drugs to the US. But if Americans worry that tariffs will immediately inflate their bills at the pharmacy, they can rest easy — at least for now. “This is not like avocados,” said Mina Tadrous, a professor at the University of Toronto who studies drug policy. A local grocery store can quickly pass the cost of tariffs on by simply reaching for the price tag gun. But the maze of middlemen between patients and the makers of medicines is far more complex. Americans already pay more for drugs than anyone else in the world. These prices are downstream from a series of negotiations between their insurance companies, pharmacy benefits managers and the manufacturers. It’s a maddeningly opaque system, but typically it results in a contract that locks in a price for each medicine. A similar process takes place for drugs administered in hospitals. (You’re on your own for ones like Botox that you pay for directly.) That means drug companies, annoyed as they might be by tariffs, can’t just kick the increased cost down the road to their customers, said Rena Conti, a health policy professor at Boston University. In the years to come, manufacturers might renegotiate their contracts to recoup the cost of tariffs, and there’s nothing to stop them from charging as much as possible for new drugs coming onto the market, Conti said. Over time, the tariffs will work their way through the system, and eventually consumers will feel the pinch. “Most patients are not paying for this directly, but they’re going to pay through their premiums, or their employers will,” Tadrous said. That’ll add to what academics call “medical inflation,” the ever-escalating cost of keeping Americans healthy. Premiums for employer-sponsored health insurance rose 7% last year, according to a KFF study, adding up to an average of $25,572 per family. — Damian Garde Trade wars, tariff threats and logistics shocks are upending businesses and spreading volatility. Understand the new order of global commerce with the Supply Lines newsletter. | 
