Pharma giants under pressure in the US: price cuts or drastic sanctions

US President Donald Trump has launched a new offensive against excessive drug prices. Last week he publicly announced the sending of official letters to 17 of the world's largest pharmaceutical companies, asking them to reduce prices within 60 days. The letters, made public individually on the Truth Social platform, were addressed to giants such as Pfizer, AstraZeneca, Sanofi, Merck, Johnson & Johnson and Eli Lilly. Trump stressed that, in the absence of firm commitments, he "will use all the tools at his disposal to protect American families" from what he called "abusive pricing practices".

• The "most favored nation” policy is back in force

This initiative comes in the context of the reactivation, in May, of a controversial policy previously signed by Trump: "most favored nation.” It requires that drug prices in the US be aligned with the lowest prices practiced in developed countries. According to a study conducted by the RAND Corporation, Americans pay on average two to three times more for drugs than citizens of other developed countries, and in some cases, the differences reach up to ten times.

In the letters, Trump accuses pharmaceutical companies of trying to shift the blame and promote policies that favor the industry at the expense of patients.

Among the demands made are: applying the lowest international price for all drugs in the portfolio, especially for Medicaid patients; contractual guarantees that Medicare, Medicaid and private insurers will benefit from the same favored prices; eliminating intermediaries through direct sales models to patients or companies; tough negotiations with countries considered to be "profiteers” of American innovation in the pharmaceutical sector. "We will no longer tolerate a situation in which foreign nations benefit for free from our progress while Americans pay the maximum price,” Trump declared.

• Immediate impact on the stock market: drops of up to 8%

The stock market reacted promptly to the announcement of the American leader. Sanofi shares fell by more than 8%, while GSK, Merck and Bristol Myers Squibb lost between 3% and 5%. Analysts warn that the pressure on the pharmaceutical industry will continue to increase.

• Industry's first reactions: silence, testing and alternatives

So far, most of the companies targeted have not issued official responses. However, AstraZeneca recently confirmed that it has proposed price cuts for certain drugs, and the Trump administration is reviewing these initiatives. At the same time, companies like Eli Lilly and Pfizer are already testing direct-to-patient sales models, without intermediaries - a measure that could become essential to avoid future sanctions. By positioning himself as a defender of the average American against the "greed” of pharmaceutical companies, Trump is reinforcing his populist and anti-establishment message. It remains to be seen whether this pressure will generate real price reductions or escalate into a major political and commercial conflict with global implications for the pharmaceutical industry. What is certain is that the next 60 days will be decisive.