WASHINGTON – President Donald Trump has applied tariffs to goods from nearly every country worldwide. He has specifically targeted imports such as cars, steel, and aluminum.

But he isn’t done yet.

Trump has committed to implementing substantial import taxes on pharmaceuticals, a category he has largely exempted from his trade confrontations. Historically, imported medications have mostly entered the U.S. without tariffs.

This is beginning to change. U.S. and European officials recently unveiled a trade agreement that involves a 15% tariff on certain European products, such as pharmaceuticals, entering the United States. Trump is also considering raising duties to 200% on drugs produced in other regions.

According to Maytee Pereira from the tax and consulting firm PwC, Trump’s approach towards drug manufacturers can be characterized as “shock and awe.” “This industry is transitioning from no tariffs to facing the possibility of 200% tariffs.”

Trump has assured Americans that he will reduce their medication expenses, but high tariffs on pharmaceuticals could have the opposite effect. It could complicate intricate supply chains, eliminate inexpensive foreign-made generic drugs from the U.S. market, and cause shortages.

“A tariff would primarily harm consumers, who would face rising costs directly at pharmacies and indirectly via heightened insurance premiums,” Diederik Stadig, a healthcare economist with ING, elaborated in his commentary last month, noting that the burden would be greatest on low-income families and seniors.

The threat comes as Trump also pressures drugmakers to lower prices in the United States. He recently sent letters to several companies telling them to develop a plan to start offering so-called most-favored nation pricing here.

But Trump has said he’d delay the tariffs for a year or a year and a half, giving companies a chance to stockpile medicine and shift manufacturing to the United States — something some have already begun to do.

Leerink Partners analyst David Risinger said in a July 29 note that most drugmakers have already increased drug product imports and may carry between six and 18 months of inventory in the U.S.

Jefferies analyst David Windley said in a recent research note that tariffs that don’t kick in until the back half of 2026 may not be felt until 2027 or 2028 due to stockpiling.

Moreover, many analysts suspect Trump will settle for a tariff far lower than 200%. They also are waiting to see whether any tariff policy includes an exemption for certain products like low-margin generic drugs.

Still, Stadig says, even a 25% levy would gradually raise U.S. drug prices by 10% to 14% as the stockpiles dwindle.

In recent decades, drugmakers have moved many operations overseas – to take advantage of lower costs in China and India and tax breaks in Ireland and Switzerland. As a result, the U.S. trade deficit in medicinal and pharmaceutical products is big — nearly $150 billion last year.

The COVID-19 experience – when countries were desperate to hang onto their own medicine and medical supplies — underscored the dangers of relying on foreign countries in a crisis, especially when a key supplier is America’s geopolitical rival China.

In April, the administration started investigating how importing drugs and pharmaceutical ingredients affects national security. Section 232 of the Trade Expansion Act of 1962 permits the president to order tariffs for the sake of national security.

Marta Wosińska, a health policy analyst at the Brookings Institution, says there is a role for tariffs in securing U.S. medical supplies. The Biden administration, she noted, successfully taxed foreign syringes when cheap Chinese imports threatened to drive U.S. producers out of business.

Trump has bigger ideas: He wants to bring pharmaceutical factories back to the United States, noting that U.S.-made drugs won’t face his tariffs.

Drugmakers are already investing in the United States.

The Swiss drugmaker Roche said in April that it will invest $50 billion in expanding its U.S. operations. Johnson & Johnson will spend $55 billion within the United States in the next four years. CEO Joaquin Duato said recently that the company aims to supply drugs for the U.S. market entirely from sites located there.

But building a pharmaceutical factory in the United States from scratch is expensive and can take several years.

And building in the U.S. wouldn’t necessarily protect a drugmaker from Trump’s tariffs, not if the taxes applied to imported ingredients used in the medicine. Jacob Jensen, trade policy analyst at the right-leaning American Action Forum, notes that “97% of antibiotics, 92% of antivirals and 83% of the most popular generic drugs contain at least one active ingredient that is manufactured abroad.’’

“The only way to truly protect yourself from the tariffs would be to build the supply chain end to end in the United States,’’ Pereira said.

Brand-name drug companies have fat profit margins that provide flexibility to make investments and absorb costs as Trump’s tariffs begin. Generic drug manufacturers do not.

Some may decide to leave the U.S. market rather than pay tariffs. That could prove disruptive: Generics account for 92% of U.S. retail and mail-order pharmacy prescriptions.

A production pause at a factory in India a couple years ago led to a chemotherapy shortage that disrupted cancer care. “Those are not very resilient markets,” Brookings’ Wosińska said. “If there’s a shock, it’s hard for them to recover.”

She argues that tariffs alone are unlikely to persuade generic drug manufacturers to build U.S. factories: They’d probably need government financing.

“In an ideal world, we would be making everything that’s important only in the U.S.,’’ Wosińska said. “But it costs a lot of money … We have offshored so much of our supply chains because we want to have inexpensive drugs. If we want to reverse this, we would really have to redesign our system … How much are we willing to spend?”

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Murphy reported from Indianapolis. AP Health Writer Matthew Perrone contributed to this report.