In 2024, the United States had a $115.5 billion trade deficit in pharmaceutical products, which the Trump administration has suggested it might try to equalize through tariffs. Through the first half of 2025, the pharmaceutical trade deficit was $72.7 billion, putting the full year on pace to exceed the 2024 deficit. 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.
On September 25, President Trump threatened to hit branded and patented pharmaceutical imports with a 100% tariff starting on October 1, with exemptions available for companies that manufacture drugs in the U.S. or plan to do so.
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 include 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. The trade deficit for pharmaceuticals through the first half of 2025 was $72.705 billion, a roughly $18 billion expansion year-over-year.
In 2024, the largest U.S. trade deficit in pharmaceutical products was 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 in 2024 and the first half of 2025.
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.
In the first half of 2025, the U.S. imported $25.7 billion worth of pharmaceuticals from Ireland and exported $2.7 billion, putting the year on pace for a record bilateral pharmaceutical goods trade deficit.
Some of the largest pharmaceutical companies have longstanding operations in Ireland, including Pfizer (PFE -0.08%), Lilly (LLY -2.05%), and Amgen (AMGN -0.67%). 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. 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. Both imports and exports dropped in the first half of 2025 year-over-year and as a result, the U.S. pharmaceutical trade deficit with Singapore stood at -$6.7 billion, on pace to be slightly lower in 2025 compared to 2024.
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 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.
Pharmaceutical trade with India accelerated in the first half of 2025. The United States imported $8.9 billion worth of pharmaceuticals and exported $472 million, leaving a trade deficit of -$8.4 billion, on pace to be a record gap.
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
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