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Paloma’s patient community depends on thyroid hormone medications for hypothyroidism treatment, hormone replacement therapy (HRT) for perimenopause and menopause, and popular GLP-1 drugs like Ozempic, Wegovy, and Zepbound for weight loss. The Trump administration’s proposed 2025 tariffs—including those on imported medications and pharmaceutical ingredients—raise concerns. While the stated goal is to boost U.S. manufacturing, experts predict rising prices and supply chain strain.

While the stated goal of the tariffs is to boost homegrown U.S. manufacturing of these prescription medications, experts predict that the real-world impact will mean steeper prices and tighter supply. 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 all categories of medications. 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

In the short term, these brand-name levothyroxine drugs are less likely to see immediate price hikes compared to generics. It’s expected that the larger pharmaceutical companies, with higher profit margins, will, for a time, absorb the costs of new or increased tariffs rather than pass them directly to consumers.

Over time, if tariffs persist or increase, there is a strong possibility that the additional costs will be passed on to consumers and payers, including government health programs like Medicare and Medicaid and patients with high-deductible or coinsurance-based insurance plans.

Generic levothyroxine

Generic levothyroxine is typically much less expensive than brand-name products and has very slim profit margins. Generic manufacturers of levothyroxine -- and suppliers of the API -- include Mylan, Sandoz, Lannett, Lupin, Teva, Dr. Reddy’s, Amneal, Accord,  Macleods, Piramal, LGM, Yaral, Sinoway, Bracco, Favine, and Peptido. While some of these companies have manufacturing facilities in the U.S., many are located outside the U.S., and a significant percentage of the API for generic levothyroxine is manufactured abroad and, therefore, subject to tariffs.

Tariffs on imported API and finished drugs could disrupt these supply chains, increasing production costs for these manufacturers, who already operate on very thin profit margins. Experts warn that these additional costs could force some companies out of the U.S. market, exacerbate existing drug shortages, and drive up prices for consumers.

Prices could especially be affected if generic levothyroxine stockpiles run low or manufacturers face higher costs. Unlike branded drugs, generics are less protected by rebates and government programs, making it easier for manufacturers to raise prices in response to increased costs from tariffs.

In general, tariffs on levothyroxine—whether applied to finished drugs or APIs—are expected to increase costs for U.S. consumers, with the impact depending on the origin of the API and the structure of the supply chain. The generic nature and globalized production of levothyroxine make it especially vulnerable to price increases and supply disruptions from tariffs.

Liothyronine is a synthetic version of triiodothyronine (T3). The brand name liothyronine is Cytomel, which is manufactured by King Pharmaceuticals in the U.S.

The majority of generic liothyronine sodium tablets supplied to the U.S. are manufactured in India.

The API for liothyronine is typically sourced from global suppliers, including manufacturers in India (e.g., Biophore India Pharmaceuticals), Spain (Bioiberica), and China (AASraw Biochemical Technology). Finished product manufacturers for generic liothyronine also include companies in India and other international locations. These companies include Biocon Pharma, Dr. Reddy’s Laboratories, Sigmapharm Laboratories, Sun Pharmaceutical Industries, Teva, and Zydus Lifesciences.

In the short term, it’s anticipated that the brand Cytomel will initially absorb tariff costs due to higher profit margins and existing insurance contracts. Over time, renegotiated contracts and persistent tariffs could lead to price increases, particularly for Medicare/Medicaid programs and patients with high-deductible plans.

Generics face greater vulnerability. Tariffs on imported medications and APIs could raise U.S. prices significantly, and with low profit margins, manufacturers have little room to absorb costs. Also, tariffs may force some overseas generic manufacturers to exit the U.S. market, reducing product availability.

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.

FDA has issued alerts regarding quality concerns with certain Chinese API suppliers. However, there is no public confirmation that Armour or NP Thyroid’s APIs are coming from China.

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 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. However, rising tariffs on finished drugs and active pharmaceutical ingredients (APIs) could impact costs.

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. Over time, however, sustained or higher tariffs could increase prices for brand name NDT drugs.

Uninsured patients already pay high cash prices—about $55–$59 per month—and may see direct increases from higher production or importation costs.

Generic NDT, which relies more on imported APIs, may be hit harder. Tariffs could raise prices by as much as $0.12 per pill.

Shortages

The U.S. periodically experiences NDT shortages due to recalls and raw material issues. Tariffs could worsen delays by making APIs more expensive and harder to source.

Though brand name manufacturers are more resilient, ongoing tariffs could still disrupt supply chains if they struggle to secure affordable inputs.

Many hormone replacement therapy (HRT) drugs like estrogen and progesterone --  used to alleviate perimenopausal and menopausal symptoms and other hormonal imbalances -- are manufactured using imported ingredients or are produced overseas. The proposed tariffs could increase the cost of these medications, potentially making them less accessible to those in need.

Many brand-name drugs are manufactured and sourced domestically, so the tariffs are less likely to affect them significantly. Several brands face some exposure, however, as their APIs are imported.

Generics and compounded bioidentical hormones are highly exposed, as their APIs and finished products are often imported from China and India.

Ultimately, new tariffs in 2025 could increase costs, impact access to affordable HRT, and trigger supply shortages, especially for generics and compounded therapies.

GLP-1 receptor agonists used to treat diabetes -- such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) – are in higher demand than ever before due to their popularity as effective weight loss medications. These drugs are typically manufactured by global pharmaceutical giants, with production and supply chains spanning multiple countries.

The threat of tariffs has already caused significant market volatility, with leading GLP-1 agonist manufacturers like Eli Lilly and Novo Nordisk experiencing sharp declines in stock value due to market uncertainty. Eli Lilly is better positioned going forward, as they have already taken steps to bring their production back to the U.S. Meanwhile, Novo Nordisk has operations outside the U.S. and relies heavily on imported APIs. Tariffs could force them to seek new manufacturing partners or absorb higher costs, potentially resulting in layoffs and reduced R&D investment. Eventually, prices are likely to increase to help cover the costs of rising tariffs.

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.

For generic semaglutide and tirzepatide, including the APIs used in compounded GLP-1 receptor agonist drugs, most of them are manufactured outside the U.S. – predominantly in China and India – by companies including Xi’an Tian Guangyuan Biotech, Chongqing Sintaho Pharmaceutical, Senova, Apino, Sinoway, Dr. Reddy’s, AXXO, Rochem, Teva, LGM, and CordenPharma. Tariffs will affect the cost of these APIs and potentially make generic and compounded GLP-1 drugs more expensive.

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.