In this article

Paloma’s patient community relies on thyroid hormone medications for hypothyroidism, hormone replacement therapy (HRT) during perimenopause and menopause, and popular GLP‑1 drugs like Ozempic, Wegovy, and Zepbound for weight management.

Under the administration’s 2025 policy agenda, the U.S. is pursuing new tariffs on pharmaceutical imports. The Commerce Department launched a Section 232 investigation into drugs, APIs, and related products in April 2025. Beginning in August of 2025, tariffs could start as low as 25% and rise to up to 200% within 12 to 18 months, reportedly to give drugmakers time to adjust.

Although many pharma companies have been stockpiling raw materials and finished drugs—providing an estimated buffer of 6 to 18 months—analysts caution that once those inventories run down, higher production costs are likely. The burden could particularly fall on generic drug manufacturers, operating on razor-thin margins, who may withdraw from the U.S. market, risking drug shortages and price hikes for everyday therapies such as thyroid meds, HRT, and GLP‑1 treatments.

This article explores the potential impact of these tariffs on patients managing chronic hormonal health conditions.

Note: Listen to this 15-minute Paloma podcast that takes a deep dive into the issue of tariffs and the possible impact on your medications.

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On April 2, 2025, the Trump administration imposed a 10% baseline tariff on most imports, though pharmaceuticals were initially exempted. However, Commerce Secretary Howard Lutnick has confirmed that the administration will be adding new tariffs on pharmaceuticals, with rates potentially exceeding 25%.

These tariffs could apply to active pharmaceutical ingredients (APIs) and finished drugs imported from China, India, and other key suppliers. There is also the potential for an even more significant tariff increase for Chinese imports, one of the top suppliers of imported drugs and APIs.

The administration’s stated goal is to reduce dependency on foreign sources and address pricing disparities, specifically, the higher prices most Americans pay for medications compared to most other nations. President Trump has argued that tariffs are justified as a way to encourage local manufacturing of pharmaceuticals and reduce their prices.​

At the same time, an executive order has indicated that price negotiations for certain drugs should be delayed.

These developments depart from previous policies where medications were largely exempt from tariffs. Given that a significant portion of generic drugs and their active ingredients are sourced internationally, tariffs will also have the ability to strain supply chains and increase costs for consumers.​ In the next section, let’s review the effect of tariffs on the medications commonly used by members of the Paloma Health patient community.

Tariffs on pharmaceuticals can be complex. For a single API drug, the tariff is usually based on the country of manufacture for the API. No matter where the finished drug is packaged or produced, the tariff rate for the country supplying the API – i.e., China – is applied.

Paloma has a 5-minute recap video that summarizes key things you need to know about the effect of tariffs on medications.

Thyroid patients typically take thyroid hormone replacement drugs, which fall into three categories:

• Levothyroxine, a synthetic form of the thyroxine (T4) thyroid hormone
• Liothyronine, a synthetic form of the triiodothyronine (T3) hormone
• Natural desiccated thyroid (NDT), a natural drug derived from porcine (pig) thyroid, that contains natural forms of both T4 and T3

Paloma patients receiving hormone replacement therapy (HRT) are frequently prescribed bioidentical medications that provide additional estrogen or progesterone for relief of the symptoms of perimenopause and menopause.

Some Paloma patients are losing weight in part with treatment using GLP-1 medications.

How are tariffs likely to affect Paloma’s patient community? The tariffs have broad implications for anyone taking medication. Specifically, the proposed tariffs could worsen existing drug shortages in the U.S., especially for generic medications, given that 70-80% of generic drugs are manufactured or sourced internationally.

The additional expenses incurred by manufacturers and distributors due to tariffs are, over time, almost always passed down to consumers, leading to higher out-of-pocket costs for medications. As a result, tariffs will likely raise healthcare costs for patients, especially for the uninsured, underinsured, and those relying on Medicare and Medicaid.

Another general implication of tariffs is a concern about the quality of medications in the future. Increased overseas production costs may lead manufacturers to cut corners, potentially affecting drug quality.

Thyroid hormone replacement medications are among the most prescribed drugs in the U.S. Many of these medications are generic and produced overseas, primarily in India and China.

The most commonly prescribed thyroid medication is levothyroxine, which is available in both generic and brand-name forms.

Brand name levothyroxine

In the U.S., the most commonly prescribed brand-name levothyroxine drugs include:

• Synthroid tablets, manufactured by AbbVie Inc.
• Levoxyl tablets, manufactured by Pfizer Inc.
• Unithroid tablets, manufactured by Jerome Stevens Pharmaceuticals
• Euthyrox tablets, manufactured by Merck
• Tirosint gel capsules, manufactured by IBSA Institut Biochimique
• Tirosint-Sol oral solution, manufactured by IBSA Institut Biochimique

Brand-name levothyroxine is often manufactured domestically or regionally in FDA-registered facilities and may be less immediately impacted by tariffs—particularly if their APIs are sourced from tariff-exempt countries or pre-existing stockpiles. Additionally, large pharmaceutical companies often have higher margins and more pricing flexibility, allowing them to absorb some of the initial tariff costs.

However, if if tariffs persist or increase over time—potentially up to 200%, as proposed—these companies may eventually pass the costs on to consumers, insurers, and public programs like Medicare and Medicaid. Patients with high-deductible plans or coinsurance-based coverage could be particularly affected.

Generic levothyroxine

Generic levothyroxine is widely used because of its affordability -- it's significantly less expensive than brand names -- but it operates on razor-thin profit margins. Leading generic manufacturers and API suppliers include:

• Mylan, Teva, Sandoz, Lupin, Dr. Reddy’s, Lannett, Amneal, Accord, Macleods, Piramal, and others
• API suppliers include Sinoway, Favine, Peptido, and additional Chinese and Indian firms

Many of these companies rely on APIs manufactured in tariff-targeted countries, particularly China. Under U.S. trade rules, tariffs are based on the country of origin of the API, even if the final drug is packaged elsewhere. Therefore, even generics labeled “Made in the USA” may face steep tariff-related cost increases.

Experts warn that:

• Tariffs on APIs and finished generics could disrupt supply chains
• Cost increases could force smaller generic manufacturers to exit the U.S. market
• Ongoing drug shortages could worsen, especially as stockpiles deplete
• Price spikes are likely, especially for uninsured or underinsured patients

Unlike brand-name drugs, generics lack the rebate protections and pricing agreements common in government and employer plans, making them more vulnerable to rapid price escalation in response to tariff-related cost pressures.

Outlook for U.S. patients

Whether applied to APIs or finished tablets, tariffs on levothyroxine are expected to raise costs for U.S. consumers, disrupt pharmaceutical availability, and create volatility in pricing—particularly for generics. With most generic drug components imported, and limited U.S. infrastructure for domestic production, the levothyroxine market remains highly sensitive to international trade policy shifts.

Patients should monitor for pricing changes and discuss alternatives with their healthcare providers. In some cases, brand-name products may become temporarily more cost-competitive, especially if generic prices rise due to tariff pressures.

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Liothyronine is a synthetic form of the active thyroid hormone triiodothyronine (T3). In the U.S., it is available in brand name and generic formulations. Liothyronine is most often prescribed for patients who do not fully respond to levothyroxine alone or who have low circulating T3 levels.

The brand-name version, Cytomel, is currently marketed by King Pharmaceuticals, a subsidiary of Pfizer, and is manufactured in the U.S. While Cytomel may initially avoid the full brunt of upcoming pharmaceutical tariffs—particularly on imported ingredients—it may still be affected if its API is sourced from countries like China or India, which are targeted under the new tariff framework.

In the short term, Pfizer is expected to absorb initial tariff-related cost increases through insurance contracts and higher margins. However, if tariffs on pharmaceutical imports scale up to the proposed 200% over the next 12 to 18 months, increased costs may eventually be passed on to insurers, Medicare/Medicaid, and patients with high out-of-pocket costs.

Generic liothyronine sodium tablets—commonly used as a lower-cost alternative to Cytomel—are far more exposed to supply chain disruptions and price volatility from tariffs.

Key generic manufacturers and suppliers include:

• API Suppliers: Biophore India Pharmaceuticals (India), Bioiberica (Spain), and AASraw Biochemical Technology (China)
  

• Finished product manufacturers: Dr. Reddy’s Laboratories, Sun Pharmaceutical Industries, Biocon Pharma, Zydus Lifesciences, Teva, and Sigmapharm Laboratories, among others

Many of these global suppliers manufacture either the API, the finished drug, or both outside the U.S.—particularly in India and China, two countries whose pharmaceutical exports are squarely in the crosshairs of the new Section 232 tariffs.

The risks and anticipated impacts on liothyronine include the following:

• Tariffs on imported APIs or tablets could significantly raise costs
• Generic manufacturers operate on low profit margins, limiting their ability to absorb these increases
• If supply chains are disrupted or become unprofitable, some manufacturers may exit the U.S. market
• A reduction in competition could lead to drug shortages and price spikes

Unlike brand-name drugs, generics are less insulated by rebates, price caps, or Medicare protections, making it easier for suppliers to adjust pricing rapidly in response to tariff-related cost pressures.

The potential impact of current and proposed tariffs poses significant challenges for brand name and generic natural desiccated thyroid (NDT) drugs.

Source of the API

All NDT drugs use porcine-derived desiccated thyroid powder—Thyroid USP—as the active pharmaceutical ingredient (API). Multiple global manufacturers produce Thyroid USP.

The two brand-name NDT drugs available on the U.S. market are Armour Thyroid (AbbVie) and NP Thyroid (Acella). Neither company discloses its API manufacturer or whether it’s sourced domestically or internationally. They confirm using porcine thyroid glands but provide no further supply chain details. However, it’s important to note that APIs for NDT drugs have historically come from China, and the FDA has issued alerts regarding quality concerns with some Chinese suppliers. However, there’s no public confirmation that Armour or NP Thyroid source their APIs from China.

As of April 2025, RLC Labs’ WP Thyroid and Naturethroid remain on back order following a 2020 recall, with no return date announced. These brands used API from Specialty Process Labs (SPL), a U.S.-based company using North American sourced material. Currently, RLC is the exclusive distributor of SPL’s API to compounding pharmacies for custom NDT formulations.

It’s likely that at least some API in the two currently available brands is internationally sourced. For generic NDT drugs, foreign API use is even more probable.

Patients seeking transparency on API sourcing and potential price breaks from non-imported API may opt for compounded NDT from pharmacies using U.S.-sourced API, such as that from SPL.

Costs

Brand-name natural desiccated thyroid (NDT) drugs like Armour Thyroid and NP Thyroid are priced at a premium and have a relatively stable supply chain. In the short term, the brand name manufacturers will likely absorb much of the added expense rather than pass it on to patients, since the drugs are already at the high end of what insurers and patients can bear. Insurance companies typically negotiate fixed rates, and brand-name drugmakers have higher margins, allowing more flexibility. For insured patients, copays and coinsurance determine out-of-pocket costs, so immediate price hikes are unlikely. However, as tariffs phase in—starting Aug 1, 2025, and possibly reaching 200% on APIs—these added costs for brand name NDT drugs will eventually affect insurance reimbursements and copays.

Uninsured patients are likely to be the hardest hit. They already pay high cash prices—about $55–$59 per month—and may see direct increases from higher production or importation costs.

Generic NDT (when available), which relies more on imported APIs, may be hit harder. Tariffs could raise prices by as much as $0.12 to $0.20 per pill, with manufacturers less able to absorb losses.

Shortages

The U.S. already experiences recurrent NDT shortages due to recalls and supply chain issues. Tariffs could worsen delays by making APIs more expensive and harder to source, particularly for smaller producers.

Though brand name manufacturers are more resilient and could weather initial phases, ongoing and increasing tariffs could still disrupt supply chains.

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Hormone replacement therapy (HRT) drugs—including estrogen and progesterone formulations used for menopausal and perimenopausal symptom relief—is increasingly vulnerable to shifts in the global supply chain. Many of these drugs rely on imported APIs or are manufactured overseas, particularly in countries like China, India, Mexico, and Canada. In 2025, several new U.S. tariffs, including “reciprocal” IEEPA tariffs and Section 232 tariffs, have been implemented or expanded. These tariffs now apply to a broad range of pharmaceutical ingredients and finished medications, raising concerns about cost and accessibility for HRT users.

Brand-name HRT medications are generally more insulated from immediate impacts because many are produced domestically or source ingredients from countries with minimal tariff exposure. However, some manufacturers may still face higher costs if they rely on imported APIs. While brand-name manufacturers often have higher profit margins and established insurance contracts, persistent or rising tariffs could eventually lead to increased production costs, which may be passed on to insurers and patients over time.

Generic HRT products and compounded bioidentical hormones face greater exposure. These drugs often rely on APIs and finished products imported from countries affected by the new tariffs—particularly China and India. Because generics operate on tighter profit margins, manufacturers may have little ability to absorb increased costs. This could lead to higher prices for consumers, reduced availability, or even market withdrawal by some manufacturers. Compounding pharmacies are particularly vulnerable, as many source hormone powders internationally. Patients relying on affordable, custom-compounded HRT may face sharp price hikes or limited access.

In the short term, patients with insurance coverage for brand-name products may not experience significant changes in out-of-pocket costs. However, uninsured patients or those using compounded or generic HRT are likely to feel the impact first. Already, some pharmacies and providers report increased costs and potential delays in sourcing certain hormone therapies.

Industry-wide, pharmaceutical manufacturers are beginning to explore strategies to mitigate the effects of tariffs. These include reshoring production, diversifying global supply chains, and negotiating new sourcing contracts. However, such transitions are complex and will take years to implement. In the meantime, cost pressures and supply chain disruptions remain a serious concern, especially for patients relying on imported or non-brand hormone treatments.

Patients are encouraged to monitor changes in their prescription costs, especially if they use generic or compounded HRT. Those who experience significant increases or difficulty filling prescriptions may want to discuss alternatives with their healthcare providers, such as switching to brand-name options that are less affected by international tariffs. Insurance companies should also be alerted to these emerging issues, especially if pricing or availability changes significantly over the next 6–12 months.

GLP-1 receptor agonists—such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound)—are experiencing unprecedented demand, largely driven by their efficacy in weight loss and diabetes management.

Among brand-name manufacturers, Eli Lilly is poised to endure better than most. The company has already made significant strides toward reshoring production, including a $27 billion investment in U.S. manufacturing—three sites focused on APIs and one for injectables, and has secured larger domestic API stockpiles to insulate against tariffs.

Novo Nordisk remains more exposed to tariff noise due to its reliance on imported APIs and European production, though it too maintains a strong U.S. manufacturing presence. Potential tariff pressure could force the company to seek new suppliers, absorb higher costs, or accelerate reshoring efforts.

Although GLP‑1 costs are already high—many patients pay out-of-pocket—any tariff-related price increases would likely be passed on directly, affecting affordability and access, especially among uninsured or self-pay patients. At the same time, the administration has indicated that it intends to pressure the industry to lower the cost of GLP-1 medications.

On the generic and compounded front, most semaglutide and tirzepatide alternatives rely on imported APIs from China, India, and other countries. Companies like Xi’an Tian Guangyuan, Dr. Reddy’s, Teva, and CordenPharma produce these ingredients, which would be subjected to new tariffs.

In general, since many patients already pay out-of-pocket for GLP-1 drugs, tariff-induced price increases would directly impact affordability and access, potentially limiting the availability of these therapies.

As we discussed earlier, the stated objective of tariffs is for the U.S. pharmaceutical industry to reduce its dependence on overseas manufacturing by driving domestic U.S.-based production. Achieving this objective poses two specific challenges:

1. Creating enough pharmaceutical manufacturing operations in the U.S. to meet the demand for various drugs
2. Accessing enough active pharmaceutical ingredients (APIs) to meet the needs of U.S. pharmaceutical manufacturing

Pharmaceutical manufacturing in the U.S.

Ramping up domestic manufacturing of medications is a multi-phase process that involves regulatory, infrastructural, and operational steps. As companies weigh a shift to possible U.S. production, the following is a best-case scenario timeline for this process — assuming minimal bureaucratic delays, fast-track approvals, available funding, and smooth execution.

Step 1: Feasibility study and planning – During this phase, which in a best-case scenario would require 1 to 2 months for market analysis, technical feasibility, and project planning to occur.

Step 2: Regulatory consultation with FDA – This step, which would take at least a month, would involve initial engagement with the Food and Drug Administration (FDA) to define the regulatory path for the domestically produced medication.

Step 3:  Facility selection or construction – This step involves site selection, construction, and retrofitting of an existing plant or fast-track construction of a new facility, requiring 6 to 12 months or more for complex products or those requiring specialized equipment. (Some people point to the speed of vaccine manufacturing during the height of the COVID-19 pandemic but keep in mind that vaccine production facilities were able to get up and running in 12 to 18 months because they had unprecedented government support, regulatory flexibility, and massive investment—conditions not typical for most drugs.

Step 4: Tech transfer / process Development – This step, which would require approximately 2 to 3 months, involves transferring formulation and production knowledge from the foreign to the U.S. team.

Step 5: Equipment procurement and installation – At this stage, 3 to 4 months would be required for manufacturing equipment to be purchased and installed.

Step 6: Staff hiring and training – This step, which would require 1 to 2 months and could ideally occur at the same time as Step 5, would involve hiring skilled personnel, especially quality assurance, quality control, and production experts. However, it’s important to note that there is currently a labor shortage of experienced chemical and bioprocess engineers, technicians, and other specialized workers in the U.S. market, which can bottleneck new projects. Restrictions on immigration could worsen this labor shortage.

Step 7: GMP validation and quality control setup – During this 2- to 3-month phase, the facility and processes are evaluated to ensure they meet FDA standards.

Step 8: FDA inspections and approvals – This process, which would require 6 to 10 months, would involve filing an Abbreviated New Drug Application (ANDA) for generic drugs or a New Drug Application (NDA) for a new drug,

Step 9: Commercial production launch – At this point, the pharmaceutical company can begin full-scale production and distribution in the U.S.

The following graphic summarizes the timeline for a best-case scenario launch of a medication for domestic production.

Assuming a generic drug (ANDA route), fast-track FDA pathways, and available infrastructure, as you can see, the best-case scenario is that it would require from 2 to 3 years for a drug to become available. The timeline for new drugs or biologics could extend to 5 to 7 or more years due to clinical trials and more rigorous regulatory pathways.

The issue of APIs

The biggest challenge in shifting from importing to domestic production of medications is the availability of active pharmaceutical ingredients. APIs – the biologically active components of drugs – are the core of drug manufacturing. Without a steady, reliable supply of APIs, even the best-equipped domestic manufacturing plants can’t produce finished medications.

And here’s the central issue: most APIs are made overseas, and 70 to 80% of APIs come from India and China.

In the near term, tariffs – which would apply to imported APIs –  will likely involve cost increases, which can result in shortages, delays, and higher drug prices.

As for the goal of domestic production of APIs, there are several obstacles to achieving this in a timely manner. The U.S. lacks API manufacturing capacity. Even if the U.S. could make tablets or capsules domestically, it cannot currently make APIs at the scale required. Reshoring API production would require a massive investment in public-private partnerships, government incentives, and regulatory reform.

Nations currently manufacturing the majority of APIs used in the U.S. have lower labor costs, looser environmental regulations, and an established drug manufacturing infrastructure that would take years to recreate in the U.S.  Domestic production of APIs will be significantly more costly due to higher labor costs and the U.S. regulatory environment.

Without solving the API issue, domestic drug manufacturing won’t be viable at scale—especially for low-margin generic drugs.

In this challenging environment, it is crucial for you to have practical strategies to protect yourself against the financial impact of these policy changes and ensure continued access to the medications you need. Here are some actions you can take right now.

1. Review and adjust your insurance coverage

Ensure you have comprehensive prescription drug coverage. Health insurers often negotiate drug prices, and it’s possible that your insurer may absorb some initial tariff-related cost increases, especially for brand-name medications.

You can also consider switching to insurance plans with better drug benefits or lower out-of-pocket maximums if available during open enrollment.

2. Talk to your doctor and pharmacist

Ask about therapeutic alternatives, including different brands, generics, or similar medications that may be less affected by tariffs or shortages. (Keep in mind that generic levothyroxine drugs can pose some challenges.)

Inquire about the possibility of switching to drugs manufactured domestically, which may be less exposed to tariff-driven price hikes.

3. Stock up when possible

If your insurer and prescriber allow, consider filling a 90-day supply of essential medications to buffer against short-term price spikes or shortages.

4. Explore patient assistance programs, pharmacies, and discount programs

Many drug manufacturers and nonprofit organizations offer assistance programs and copay cards for those struggling to afford medications. These programs will become more critical when drug prices rise.

You can also shop around at different pharmacies, including online and mail-order options, as prices can vary widely. Also, consider using prescription discount cards or programs (such as GoodRx or Singlecare) to find the lowest available prices.

For information on specific programs available for thyroid medications, read Saving Money on Your Thyroid Drugs with Copay Cards.

5. Monitor policy changes and be an advocate

Stay informed about new legislation or programs that may help offset rising costs or improve access to essential medications. Consider supporting advocacy groups, state legislatures, and legislators who are actively working on measures to address drug affordability. And always advocate for yourself!

6. Communicate with your healthcare team

Let your healthcare providers know if you are having trouble affording or accessing your medications. They may be able to suggest alternatives or additional resources.

7. Prepare for potential shortages

Be proactive in refilling prescriptions before you run out, especially for medications where shortages are anticipated.

You’ll also want to discuss with your provider what to do if your usual medications become unavailable.

The current and proposed tariffs on pharmaceutical imports are poised to significantly disrupt the supply, pricing, and accessibility of critical medications for hypothyroidism, hormone replacement therapy, and GLP-1 therapies. Experts  are specifically concerned about the following issues:

• The U.S. is already facing over 270 active drug shortages. Tariffs could worsen this situation by making it financially impossible for some manufacturers to supply the U.S. market.
• Any increase in supply chain costs—whether from tariffs or other disruptions—will likely be passed on to consumers, further straining affordability and access.
• While the administration claims tariffs will incentivize domestic production, many experts are skeptical. Building or retrofitting new API and drug manufacturing capacity in the U.S. would require billions of dollars and several years, offering no immediate relief for shortages or price increases.
• Experts also caution that while some larger companies may absorb costs temporarily, most are expected to pass them to consumers or reduce investment in research and development, potentially stifling innovation.

Looking ahead, the most noticeable effects are likely to be higher prices, increased drug shortages, and reduced access for patients—especially for generics and high-demand specialty drugs. While the administration hopes to boost domestic manufacturing, experts warn that this transition will take years and may not resolve the underlying issues of affordability and supply chain fragility in the near term.

The Trump administration’s proposed tariffs on pharmaceutical imports present significant challenges to the U.S. healthcare system, particularly concerning the availability and affordability of medications for hypothyroidism, HRT, and weight loss.

Paloma Health is committed to walking beside you through every step of your health journey. Whether you’re managing hypothyroidism, navigating hormone replacement therapy (HRT), or exploring GLP-1 medications for metabolic support, we know that the road to better health can be complex. With new tariff programs and rising costs affecting access to thyroid medications, HRT, and GLP-1 drugs, we understand how overwhelming this can feel. That’s why Paloma is here to advocate for our members—not just as healthcare providers but as partners. Your Paloma care team will help you find affordable options, explore cost-saving alternatives, and ensure that no matter how policies change, you have the guidance and support you need to continue your treatment without interruption.

• The 2025 tariffs could significantly raise the cost and reduce the availability of thyroid, HRT, and GLP-1 medications, especially generics.
• Tariffs on imported pharmaceutical ingredients and finished drugs will likely exacerbate current drug shortages in the U.S.
• Generic medications, which rely heavily on international APIs and operate with low profit margins, are most vulnerable to price hikes and supply disruptions.
• Brand-name drugs may absorb some tariff costs initially, but long-term price increases are expected as companies pass expenses to consumers.
• U.S.-based pharmaceutical production will take years to scale up due to regulatory, labor, and infrastructure barriers—offering no short-term solution.
• Hormone therapies and compounded medications are also at risk, especially those using imported APIs from China and India.
• Patients can prepare by being proactive: reviewing and adjusting insurance coverage, asking providers about alternatives, using discount programs, and stocking up when possible. These actions can help buffer against the financial impact of new tariffs on prescription medications.
• Without significant investments in API manufacturing, the U.S. will remain reliant on imports—keeping the supply chain fragile and prices unpredictable.