If you were to walk into a New Jersey pharmacy and ask for a year’s supply of Eliquis, a blood thinner that millions of Americans take to prevent strokes, the list price will be in the region of $7,100. The same drug, manufactured by the same two American companies, Bristol Myers Squibb and Pfizer, at the same plant, could cost you just $770… if you lived in Berlin, Germany.

Now do the same calculation with the increasingly popular Ozempic. The list price in Cleveland is $969 a month, but in Copenhagen it costs just $122. In Berlin it’s as low as $59.

None of this is a quirk, nor is it down to cunning European negotiation. It is, in fact, one of the oldest rackets in international trade.

Americans foot the bill at both ends of all this, by the way: once as taxpayers, by publicly funding organizations like the increasingly scrutinized National Institutes of Health (NIH), which underwrites scientific developments, and a second time at the pharmacy counter, by paying the prices that allow drugmakers to absorb the discounts Berlin and Paris demand as their cost of market access.

European governments operate single-payer health systems, which they use as bottlenecks: they tell pharmaceutical companies what price they’ll pay for a given drug, and the companies, unable to walk away from entire national markets, take what they can get. And in some countries the squeeze doesn’t even stop at the register: governments use “clawbacks” to reach back into the pockets of American drugmakers after the sale and demand a refund on medicines already delivered. Whatever margin is squeezed out of Germany or France inevitably gets recouped from the one large market that does not impose statutory price controls: America’s.

Brussels calls the whole process “price negotiation,” which is one of those European terms that means the opposite of what it is.

Take Germany — Europe’s largest economy and the country that lectures the loudest about “solidarity.” For years, Berlin has forced mandatory price cuts on American medicines the moment they cross its border, suppressing what American companies can charge and sending the bill for the shortfall back across the Atlantic to American patients.

LONG-TERM MALIGNANCE.

For 70 years European governments have spent below NATO defensive spending targets, redirecting the savings into their welfare states, which the United States effectively subsidizes. The same mentality drives the medicine racket: why fund your own research when the Americans will do it for you?

Europeans often lecture Americans about the supposed cruelty of America’s “for-profit healthcare,” while running an entire continent’s pharmacopoeia on profits extracted from American patients. European Union Commissioner Ursula von der Leyen condemns capitalism during Davos, but then dispatches her negotiators to enforce the price controls that depend on it. When President Trump suggested at the same conference in January that Emmanuel Macron might consider letting French citizens pay something closer to what Americans pay for the same medicines, the French presidency dismissed the comment as “fake news.” The more accurate translation is that they consider the question itself an impertinence.

Over the past year, President Trump has expended significant effort on this.

His May 2025 ‘Most Favored Nation’ executive order put the principle on paper. By December 2025, 17 of the world’s largest medicine manufacturers (accounting for about 86% of the branded drug market) had signed deals committing to align American prices with the lowest paid in comparable developed countries.

BRINGING PRICES DOWN FOR AMERICANS.

This February, TrumpRx.gov went live, with the cash price of Ozempic falling from $1,028 to around $350 and Wegovy to as low as $149. The British, to their credit, read the room: on 1 December 2025 London signed an agreement to raise the net UK price on new drugs in exchange for tariff relief. The model, in short, works, and now needs to be turned on the governments that still refuse to apply it.

Germany didn’t learn from the UK. It is racing in the opposite direction and will likely be the first EU domino to fly in the face of Trump’s policy. Earlier this month, Berlin published a new cost-containment bill that piles fresh rebates and price cuts on top of an already rigged system.

The administration’s existing Section 301 investigation into the European Union, opened on 11 March 2026, currently focuses on things like excess industrial capacity. But it should be extended (or a parallel one opened) to cover European pharmaceutical price-setting regimes directly.

The language was written for exactly this kind of behavior: foreign government practices that are “unreasonable or discriminatory” and burden the American taxpayer and the nation’s commerce.

For half a century the deal has been that Americans pay for the discoveries and Europeans enjoy them at cut rates. Under Trump, that arrangement is coming to its end. Britain has accepted the new terms. Germany is testing whether the Administration means it. France is watching. They will all likely accept these terms in time, or they will discover at last what it feels like to pay for their own science, their own medicine, and their own defense, all of which the United States has been quietly funding on their behalf for the better part of a lifetime.