Trump’s Proposed Tariffs on Canadian Drugs Could Raise Costs and Trigger Shortages in the U.S.
The Trump administration is considering imposing tariffs on prescription drugs imported from Canada, a move that experts warn could disrupt delicate supply chains and lead to shortages of critical medications in the U.S. Historically, pharmaceuticals have been spared from such trade barriers, but that exemption may soon end.
A new research letter published in JAMA highlights the potential consequences of this policy shift. The study identifies hundreds of drugs manufactured in Canada for the U.S. market, including dozens that are predominantly or exclusively produced there. Among them are bupropion for depression, ibalizumab for multi-drug-resistant HIV, and sotalol for life-threatening heart rhythm issues—medications that could become harder to access if tariffs are applied.
Mina Tadrous, a University of Toronto professor and co-author of the letter, emphasized the stakes: “These drugs are essential for American patients, and Canada plays a key role in supplying them. Tariffs could ripple through the supply chain, affecting how these medications reach those who need them.” While he doesn’t foresee immediate catastrophe, Tadrous noted that drugs like HIV treatments, which extend lives, could become less available, ultimately compromising patient care.
Canada exports roughly $3 billion worth of pharmaceuticals to the U.S. annually. A proposed 25% tariff would add $750 million in costs, likely passed along to pharmacies and consumers. Disruptions in this fragile system could have disastrous effects.
David Zgarrick, a professor emeritus of pharmacy at Northeastern University, predicts that if tariffs take effect as early as April 2, patients and pharmacists could feel the impact within weeks. “We’re entering uncharted territory,” he said. “It’s not hard to imagine a scenario where pharmacies, patients, and healthcare providers struggle if tariffs are slapped on all medications.”
A Fragile Global System
Drug supply chains are notoriously sensitive. Past disruptions—like those worsened by the COVID-19 pandemic—have led to shortages, with the issue becoming so severe in 2023 that a Senate committee labeled it a national security concern. Tariffs could exacerbate this vulnerability, raising costs for U.S. patients in the short term and potentially destabilizing supplies over time if Canada or other nations respond with counter-tariffs.
Canadians wouldn’t be immune either. Tadrous warned that shortages could cross borders, especially for hospital-used IV drugs or medications for rare conditions. “Global supply chains don’t respect boundaries,” he said. “If the U.S. extends tariffs beyond Canada to Europe, China, or India, we could see an even tighter squeeze on supplies worldwide.”
Pharmaceutical production is a complex, global puzzle, with a single drug often relying on components from multiple countries. Adding tariffs—and counter-tariffs—could snarl this process further. Building new manufacturing capacity isn’t a quick fix either; Tadrous estimates it takes three to four years to develop a new drug and months to years to establish a production site.
Looking Ahead
American patients would bear the brunt of higher costs and potential shortages. But Tadrous urges Canada to prepare for long-term fallout. “If these tariffs go through, we need to take steps to safeguard our own supply chain—more than we’re doing already,” he said. Strengthening domestic resilience could be a years-long effort, making it critical to start planning now.