<p>The USA is highly dependent on global supply chains for both finished pharmaceutical products and the active pharmaceutical ingredients required to produce them. Recent proposals by the Trump administration to impose tariffs on imported pharmaceuticals raise profound implications for healthcare systems, providers, and patients. While branded drug manufacturers may be better positioned to absorb added costs, generic manufacturers operate on narrow margins and may discontinue products if tariffs render production financially unsustainable. Healthcare systems could face rising drug costs and drug shortages due to supply chain fragility, while patients would confront higher out-of-pocket costs, more restrictive formularies, and heightened risks of cost-related nonadherence. Although expanding US domestic pharmaceutical manufacturing is a stated policy goal, meaningful progress will require substantial investment and years to achieve, given continued reliance on foreign sources for finished products, active pharmaceutical ingredients, and key starting materials. This Perspective argues that exempting pharmaceuticals from tariffs is critical to safeguarding affordability, access, and safety, while highlighting the need for clinicians to appreciate the uncertainties and the potential consequences of trade policies on medication availability and patient care. </p>