President Donald Trump signed an executive order directing the Department of Health and Human Services’ preparedness office to create a six-month reserve of active pharmaceutical ingredients for 26 drugs deemed vital to national security and to update an existing list of 86 essential medicines. The order instructs agencies to prioritise U.S.-made ingredients and to draft plans for a second strategic stockpile, aiming to reduce reliance on foreign suppliers after reports that only about 10% of APIs used in the United States are manufactured domestically. The White House move is backed by threats of tariffs that could climb to 250% on imported medicines and follows earlier regulatory relief intended to speed approval of new drug-production facilities. A U.S. security commission found that as much as 28% of API imports came from China, underscoring supply-chain vulnerabilities highlighted during recent shortages. Drugmakers are already adjusting to the administration’s parallel push for “most-favoured-nation” pricing. Eli Lilly, which publicly endorsed the policy, has raised the U.K. list price of its weight-loss treatment Mounjaro by as much as 170% to narrow the gap with U.S. charges, a move that does not affect the price paid by Britain’s National Health Service but signals broader industry acceptance of higher prices outside the United States. Pharmaceutical companies are also increasing domestic investment. AstraZeneca and Roche have each announced $50 billion commitments to expand U.S. manufacturing, while AbbVie this week earmarked $195 million for a new API facility in North Chicago. Analysts say the combined measures could bolster U.S. drug security but caution that shifting costs abroad may do little to lower prices for American patients.