Where U.S. Medicines Are Made and How Trump’s Tariffs Could Affect Them

President Trump’s repeated threats to impose punishing tariffs on imported medicines have sparked interest in where Americans’ drugs are produced.

The picture is complex. Most of the time, drugs are not made in a single country from start to finish. More often, a factory imports raw materials that it uses to make a drug’s active ingredients, which then get shipped to a plant in another country that formulates the drug into a tablet or liquid.

U.S. Pharmacopeia, a nonprofit that sets quality standards and tracks the prescription drug supply, shared data with The New York Times that offers a window into the geography of all those shipments. The organization’s data zeros in on supply for Americans and measures it by volume.

Drugs given as injections are more likely to be formulated in the United States, while India makes most of Americans’ pills, according to the data.

Let’s dive into the details of where five popular medicines are produced.

Vulnerable antibiotics

Amoxicillin is a crucial generic antibiotic used to treat bacterial infections, like strep throat. In the United States, amoxicillin is commonly taken as a liquid.

Tariffs threaten to hit antibiotics particularly hard. The drugs have very thin profit margins, they are vulnerable to shortages and U.S. production is very limited. Other widely used and vulnerable antibiotics include ciprofloxacin and doxycycline.

Shots from Denmark

The blockbuster weight-loss medication sold as Ozempic and Wegovy, which patients inject with a pen, has a simpler origin. The drug’s Danish manufacturer, Novo Nordisk, makes all of the active ingredients in Denmark. For the next step of turning the active ingredients into the finished drug, Novo Nordisk splits the work between two countries, Denmark and the United States.

Novo Nordisk’s injection is perhaps the best-known among a wide range of expensive blockbuster medications made in Europe. These medications would be subject to 15 percent levies under the trade deal reached between the United States and the European Union last month. It’s not clear when those tariffs would take effect. Officials said these levies would hit simultaneously with other pharmaceutical tariffs that Mr. Trump has been threatening to impose elsewhere in the world.

Ambre James-Brown, a spokeswoman for Novo Nordisk, said that most of the company’s manufacturing for a tablet form of the drug is in the United States.

A shift to India

For years, Pfizer brought in billions of dollars from the ubiquitous little blue tablet sold as Viagra, making the active ingredients in Ireland. But in 2017, the erectile dysfunction drug, known as sildenafil, went generic.

That transformed the market, unleashing a wave of low-priced competition from manufacturers almost entirely in India, which handle both main phases of production there. It also helped jump-start the businesses of telemedicine companies like Hims & Hers and Ro, which capitalized on the appeal of going online to order sildenafil inexpensively and discretely.

Deep roots in China

Losartan is a tablet commonly used to treat high blood pressure. The drug is generic, with many manufacturers.

Factories in China make a majority of the drug’s active ingredients, providing an example of America’s dependence on China for medicines that has generated alarm for years. Both Republicans and Democrats have identified it as a national security vulnerability.

China also makes a substantial but poorly understood share of the raw materials that go into making drugs, a step in the process that was not captured in the data shared with The Times.

India, an American ally, handles most of the next stage of production, formulating the tablets. India’s giant generic drug sector could be hard hit by tariffs.

At risk for shortages

Lidocaine injections are widely used in hospitals to numb pain during medical procedures. In the United States, it is commonly supplied as a liquid in a vial.

The drug is generic, with manufacturers in multiple countries handling production of active ingredients and, then, the finished vials.

With thin profit margins and more complex production than simple tablets, injectable medications like lidocaine are frequently in shortage. Supply chain experts are worried that tariffs could exacerbate those long-running shortages.

Across medicines, the geography of production for other parts of the world looks similar to that for the United States, though some regions, like Latin America, rely more on local manufacturing.

Ani Matevosian contributed production.