On March 19, Japanese Prime Minister Sanae Takaichi arrives in Washington for her first official visit to the White House. The agenda will be inclusive, covering everything from defense spending, semiconductor investment, rare earths, to agriculture. That breadth reflects a deep reality — that Japan is one of America’s most important partners, a cornerstone of Indo-Pacific security, and a major investor in American communities.
As the two allies look to strengthen their economic partnership, one issue deserves far more attention than it typically gets — the price Japan pays for American-made prescription drugs.
For decades, Japan has been one of the world’s most aggressively underpriced markets for innovative pharmaceuticals. According to RAND Corporation data, Japan’s drug prices are roughly 25 percent of what Americans pay for the same brand-name medicines. Japan’s Ministry of Health mandates biennial price cuts, imposes “market expansion repricing” that slashes prices when drugs succeed, and critically has planned the extension and tightening of the drug assessment regime that punishes pharmaceutical companies for developing new treatments patients need.
This is the textbook definition of foreign exploitation. American families, employers, and taxpayers bear the overwhelming cost of pharmaceutical innovation, funding roughly 78 percent of global drug research and development, while wealthy nations enjoy the benefits at a fraction of the price. The U.S. accounts for 67 percent of global sales of new brand-name drugs, while Japan, the world’s third-largest economy, contributes a fraction of its fair share.
As a physician, I have seen firsthand both what it means when patients cannot access the treatments they need and how trade policy shapes those outcomes. President Donald Trump has been right to call out this imbalance and has already shown that his administration knows how to solve this problem — there is now a proven model.
In December 2025, the U.S. struck a historic pharmaceutical pricing agreement with the U.K., in which the NHS committed to increase what it pays for innovative medicines by 25 percent. In exchange, the U.K. secured zero-percent tariffs on pharmaceutical exports. It was a genuine win for both sides, and there is no reason the same logic cannot apply to Japan.
This is not about punishing an ally. Japan is a collaborator on everything from semiconductors to clean energy. But true partnership means shared responsibility. When Japan’s government-controlled pricing system forces American companies to sell innovative treatments at a loss — or not sell them at all — it undermines the innovation ecosystem that benefits patients in both countries.
A fairer pharmaceutical pricing agreement would strengthen the alliance, not strain it. Japanese patients would gain faster access to breakthrough therapies currently bypassing their market entirely, and American families would see the cost of global drug development distributed more fairly.
The Takaichi visit creates a natural opening to put pharmaceutical pricing on the bilateral agenda. The U.K. agreement provides a clear template that shows how meaningful commitments on net pricing and market access in exchange for favorable tariff treatment can work. Japan has already secured a commitment that its pharmaceutical exports will face tariffs no greater than any other country, but branded drug pricing has not been addressed in the existing framework. The ingredients for a deal are there. Japan wants certainty on tariffs. The U.S. wants fairness on pricing. That is the foundation of every successful negotiation.
President Trump has made clear that no American should pay more for a prescription drug than a citizen of any other wealthy country. Prime Minister Takaichi has said she wants to deepen the U.S.-Japan economic partnership.
The March 19 summit is a chance to advance both goals at once. Trade talks with Japan have produced agreements on semiconductors, agriculture, and defense. For the benefit of both countries, it is time to add pharmaceuticals to the list.
Rep. Michael C. Burgess, M.D., is a former U.S. Representative from Texas; Member, GOP Doctors Caucus; Founder of the Healthcare Caucus.
