Pharmaceutical tariffs: Which countries does the U.S. import the most from?

The United States has a $115.5 billion trade deficit in pharmaceutical products, which the Trump administration has suggested it might try to equalize through tariffs in 2026. The United States is the world’s largest importer of pharmaceuticals and the second-largest exporter.

The countries with which the United States runs the largest trade deficits in pharmaceutical products are Ireland, Switzerland, Singapore, India, and Germany. Read on for a breakdown of U.S. pharmaceutical trade statistics.

Editor’s note: Pharmaceutical products, for the purpose of this article, are encompassed in HTS groups 30.01, 30.02, 30.03, and 30.04, which includes medicaments and immunological products. The data does not include supporting medical products used in diagnosis, surgery, clinical trials, and patient care.

Where does the U.S. import pharmaceuticals from?

The United States imports pharmaceutical products from 98 countries and exports them to 193 countries. It has a pharmaceutical trade deficit with 32 countries and a surplus with 161. Despite that, in 2024, the United States had a trade deficit of $115.5 billion in pharmaceutical products.

That’s due to the United States running a pharmaceutical product trade deficit of over $1 billion with 17 countries. Its largest trade deficit in pharmaceutical products is with Ireland, at -$45.5 billion, followed by Switzerland at -$15.7 billion.

The U.S. trade deficit in pharmaceuticals has grown at a 14% annual increase on average, from $11.6 billion in 2004 to $115.5 billion in 2024. U.S. drug exports shot up 46% in 2021 amid the COVID-19 pandemic, but annual growth returned to levels closer to average in the following years.

The table and map above show the U.S. pharmaceutical trade balance with every country.

U.S. pharmaceutical trade with Ireland

Pharmaceuticals are Ireland's top export. The country is the third-largest pharmaceutical exporter in the world, and the United States is its top export market. In 2024, the U.S. imported nearly $50 billion worth of pharmaceuticals from Ireland and exported roughly $4.4 billion, leaving it with a $45.5 billion trade deficit in pharmaceuticals.

Some of the largest pharmaceutical companies have longstanding operations in Ireland, including Pfizer (NYSE:PFE), Lilly (NYSE:LLY), and Amgen (NASDAQ:AMGN). Those companies and others have set up shop in Ireland to take advantage of the country’s low corporate tax rate and competitive research and development incentives.

U.S. pharmaceutical trade with Switzerland

The U.S. exported $3.1 billion worth of drugs to Switzerland in 2024 and imported $18.9 billion, resulting in a $15.7 billion deficit.

Switzerland has attracted life sciences and medical technology investment and talent over time and has become a hub for innovation. More than 700 pharmaceutical, biotechnology, and medical device companies have a footprint in Switzerland, including some of the largest in the industry such as Roche and Novartis (NYSE:NVS).

U.S. pharmaceutical trade with Singapore

The U.S. had a $13.6 billion trade deficit in pharmaceuticals with Singapore in 2024 – it exported $1.6 billion worth of drugs and related products and imported $15.2 billion that year.

Singapore has recently become a major drug manufacturer, which is reflected in its growing pharmaceutical exports to the United States. In 2004, it exported $90 billion to the U.S. By 2014, exports amounted to $1 billion, and by 2024, they skyrocketed to $15 billion.

The drug manufacturing boom in Singapore is driven by a business-friendly corporate tax rate, a deep talent pool, strong intellectual property protections, and geographic proximity to major markets in the Asia-Pacific region. Major pharmaceutical companies with manufacturing facilities in Singapore include GSK (NYSE:GSK), Merk (NYSE:MRK), and Novartis (NYSE:NVS).

U.S. pharmaceutical trade with India

The U.S. pharmaceutical trade deficit with India has expanded over time, from $232 million in 2004 to $11.7 billion in 2024. U.S. drug exports to India have grown from $21 million in 2004 to $591 million in 2024. But imports from India have far outpaced that, ballooning from $253 million to $12.3 billion over the same period.

India is the world leader in generic drug and vaccine manufacturing, has the highest number of USFDA-approved drug manufacturing plants outside of the U.S., and supplies 40% of generic pharmaceuticals consumed in the U.S.

Growth in pharmaceutical manufacturing in India is driven by low labor costs, economies of scale, and government support for the industry. Investment in India’s pharmaceutical industry has grown since the COVID-19 pandemic as companies seek to diversify their medical supply chains, particularly for active pharmaceutical ingredients, away from China.

U.S. pharmaceutical trade with Germany

The U.S. holds a $9.1 billion trade deficit in pharmaceutical products with Germany. The deficit has shrunk in recent years as U.S. exports have trended upward and imports have declined.

Germany is a hub for medical innovation. It is among the top countries for clinical trials and pharmaceutical patent applications. Germany is a major biopharmaceutical manufacturer thanks in part to its roots in chemical production, as well as modern infrastructure and strong human capital. More than 600 pharmaceutical companies have operations in Germany, including Bayer (OTC:BAYRY), Roche (OTC:RHHBY), and Takeda (NYSE:TAK).

What investors should know about potential pharmaceutical tariffs

Investors should be aware that the Trump administration has initiated a Section 232 investigation into whether pharmaceutical imports threaten U.S. national security. The investigation may result in tariffs on pharmaceutical imports. The same type of investigation has resulted in tariffs on steel, aluminum, and automobiles. Pharmaceuticals have been exempted from the reciprocal tariffs announced in early April.

Administration officials have said that tariffs would encourage manufacturing of more pharmaceutical products in the United States. Industry associations estimate that building new drug manufacturing facilities can take 5 to 10 years and cost $2 billion.

Trade data suggests that the United States is heavily reliant on pharmaceutical imports throughout the supply chain, including precursors, active pharmaceutical ingredients, generics, and brand-name drugs. Tariffs could raise drug costs, impact the availability of ingredients and finished products, and lead drugmakers to cut spending on R&D – all of which could influence healthcare stocks.

Section 232 investigations, such as the one into pharmaceutical imports, must be complete within 270 days but may be handed in early. Investors should circle Dec. 27, 2025, on their calendars if tariff action on pharmaceuticals isn’t announced before then.