Article – The shelves at George Miller’s independent pharmacy in suburban Maryland have been filling up with more than the usual inventory. Miller, who has owned his shop for 25 years, now navigates narrow aisles crammed with cardboard boxes of generic medications that would normally arrive in smaller, just-in-time shipments.
“I’ve never stockpiled before,” Miller tells me during my visit to his pharmacy last week. “But with these tariff threats, I can’t risk not having medication for my patients who depend on me.”
Miller isn’t alone. Across the United States, pharmacists are quietly building reserves of generic medications, particularly those sourced from India and China, as concerns grow over President Trump’s promised 60% tariff on all Chinese imports and substantial tariffs on Indian pharmaceuticals if he wins the November election.
The pharmaceutical supply chain, already stressed from pandemic-era disruptions, faces new uncertainty as Trump has repeatedly emphasized his America First drug manufacturing agenda during campaign stops. At a rally in Michigan last month, he declared: “We’re going to bring pharmaceutical production back to American soil where it belongs, and foreign countries are going to pay for the privilege of selling to our market.”
This rhetoric has triggered what industry insiders are calling “preemptive hoarding” among pharmacies nationwide. The Healthcare Distribution Alliance reports that orders for certain generic medications have increased 28% since January, despite no significant change in patient demand.
Dr. Rena Conti, health economist at Boston University, explains the potential impact: “Approximately 80% of active pharmaceutical ingredients in U.S. medications come from overseas, primarily India and China. Even medications labeled ‘Made in America’ often contain ingredients sourced internationally.”
At Washington University’s Drug Policy Research Center, analysts project that implementing a 60% tariff on Chinese pharmaceutical imports would increase U.S. healthcare costs by $38 billion annually. For everyday Americans, this could mean a typical generic prescription jumping from $15 to $24 or more.
“The mathematics is straightforward but devastating,” says Conti. “These costs will be absorbed initially by pharmacies and distributors, then insurers, and ultimately passed to patients through higher premiums or direct costs.”
Walking through a distribution center in New Jersey, I observe the scale of the preparation. Pharmacy wholesaler Northeast Medical Supplies has converted office space into overflow storage. Their operations director Dave Hernandez points to shelves of heart medications, diabetes drugs, and antibiotics.
“We’re focusing on life-sustaining medications first,” Hernandez explains. “Our customers – independent pharmacies mostly – are placing orders 40% larger than this time last year.”
The American Society of Health-System Pharmacists (ASHP) has documented stockpiling behaviors across 230 hospital systems, with 68% reporting they’re building reserves of critical medications sourced from potential tariff-affected countries.
For patients like Marjorie Delaney, a 72-year-old retiree I met at Miller’s pharmacy, these industry movements translate to anxiety. “I take six medications daily, most generic. My Social Security doesn’t go up when prices go up,” she says while picking up her monthly prescriptions.
Pharmaceutical manufacturers have also begun adjusting strategies. Cipla, an Indian generic giant with significant U.S. market share, acknowledged in an investor call last quarter that they’re accelerating shipments to American distributors ahead of potential policy changes. Meanwhile, Teva Pharmaceuticals announced plans to expand U.S. manufacturing capacity – exactly the outcome Trump’s policy threats intend.
Dr. Stephen Schondelmeyer, director of the PRIME Institute at the University of Minnesota, which studies pharmaceutical economics, cautions that stockpiling itself creates problems: “We’re seeing artificial shortages of certain medications as larger buyers consume available supply. This disrupts normal distribution patterns and can leave smaller providers without access.”
The FDA has not officially commented on the stockpiling trend, but agency records show an uptick in meetings with generic manufacturers regarding supply chain resilience planning.
Beyond immediate price concerns, healthcare policy experts worry about longer-term consequences. “If implemented, substantial tariffs could fundamentally restructure the generic drug market,” explains Juliette Cubanski of the Kaiser Family Foundation. “We might see manufacturers abandoning lower-margin products entirely if production costs rise significantly.”
Back at his pharmacy, Miller shows me his inventory management system, where he’s tracking his enhanced supplies. “I’ve invested nearly $200,000 in extra inventory,” he says. “That’s money that would normally go toward expanding services or hiring another technician.”
As uncertainty continues, the healthcare system finds itself preparing for policy that hasn’t yet materialized but could have immediate consequences if implemented. Industry groups including the American Pharmacists Association have requested meetings with both presidential campaigns to discuss pharmaceutical supply chain concerns.
For now, pharmacists like Miller continue their preparations while hoping their stockpiles ultimately prove unnecessary. “Either way,” Miller sighs while closing a cabinet filled with diabetes medications, “it feels like we’re always the ones caught in the middle, trying to make sure patients don’t suffer from decisions made far above our pay grade.”
