Drugmakers Bayer, Johnson & Johnson and PhRMA were also among those to have each donated $1m to Trump’s inauguration.
But this is chicken feed compared to the investment pledges being made.
In November, AstraZeneca said it would spend $3.5bn on new investments in the US, while Eli Lilly said in February it would invest an additional $27bn in US manufacturing.
A month later, Johnson & Johnson said it would spend $55bn in the US over the next four years.
“That was a big wow,” says Trung Huynh, head of pharma analysis at UBS investment bank.
Henry Levy, a life sciences expert, says: “Lobbying has been going on for a long time, but lobbying of this type is different. It’s not something I have ever seen.”
However, drug chiefs are waking up to the painful reality that even this may not be enough.
When Trump first told reporters on a Tuesday in February that he planned to introduce 25pc tariffs on drug imports, the timing was not by chance.
“He was sitting down with the pharma lobby on the Thursday,” says Courtney Breen, a senior analyst at Bernstein, part of Société Générale Group. “That was him setting the tone to make them appropriately scared.”
Sir John Bell, one of the UK’s leading life sciences figures, says pharma bosses are increasingly resigned to the fact that new taxes are coming, even if they do not know when or what shape they will take.
“There will definitely be tariffs,” he says.
Michel Demaré, the AstraZeneca chairman, has urged Trump to change course as he warned of the potential impact on patients.
He told shareholders last week: “Medicines should be exempted from any kind of tariffs, because [in] the end, this is just harming patients, health systems and restricting health equity.”
Meanwhile, Dame Emma Walmsley, GSK’s chief executive, tried to appear positive last week when she said the situation remained “very fluid”.
However, she accepted that the threat of tariffs was something the company had been expecting for some time.
Instead of trying to block the levies altogether, many in the sector are hoping they can be delayed or phased in gradually.
The introduction of such tariffs would be a watershed moment for the sector, which for three decades has been protected from levies under an agreement with the World Trade Organisation.
As a result, companies are scrambling to “game plan” various scenarios, while share prices have tanked.
In the last month, Pfizer’s share price has dropped by nearly 19pc, while Eli Lilly, AstraZeneca and GSK were down by 13pc, 14pc and 19pc respectively.
The seismic impact of tariffs will be felt globally.
More than half of America’s drug imports – around $127bn – come from the EU, while Japan, China and India are also significant trading partners. The UK would also feel the pain.
“There’s definitely a big element of risk here because we import a lot and we export a lot,” says Sir John.
The pharma sector is the UK’s second-largest for exports to the US, coming only after cars.
Around £7.2bn worth of medicines and pharmaceutical products were sent over to America from UK ports in the 12 months to the end of October, while £4.5bn worth of stock was imported from the US.
“Pharmaceuticals is one of our biggest manufacturing sectors,” says Sir John. “That means if there’s an aggressive deal on pharmaceuticals, it will be really problematic for the UK economy.”
Trump’s problem with the pharmaceutical industry goes beyond America’s trade deficit.
Much of big pharma’s business model relies on companies basing their operations in low-tax jurisdictions, which enables them to make hefty profits when selling drugs for higher prices in the US.
“In the US, the majority of these companies don’t post a profit,” says Huynh. “In general, companies manufacture their products in a low-tax jurisdiction.”
They are then able to charge high import prices, known as transfer prices, which are often close to the retail price of a product.
If a drug costs $10 to produce, for example, a company might sell it to a US subsidiary at a transfer price of $100, says Huynh.
Instead of paying America’s 21pc corporation tax rate on the $90 profit, the company then pays a US Global Intangible Low Taxed Income (Gilti) tax rate of 10.5pc.
Breen says: “They can say, well, the US actually isn’t doing that much, they’re just a sales and distribution function and therefore you minimise the risk exposure to [US] taxes.”
Concerns over this model have existed long before Trump.
Senate finance committee (SFC) member and Democratic senator Ron Wyden is currently overseeing an investigation into tax evasion across the pharmaceutical industry.
At the end of March, he accused Pfizer of “what could be the largest tax-dodging scheme in the history of big pharma.”
In 2019, the company sold drugs worth $20bn to Americans but claimed that 100pc of its profits were earned outside of the US, according to the SFC.
Pfizer has rejected this portrayal and claimed that the company has paid $12.8bn in income taxes in the US over the last four years.
Yet this level of scrutiny is particularly problematic given Trump’s desire for US companies to pay their fair share.
The president has already complained that drugs in the US currently cost far more than those sold elsewhere.
And he does have a point. On a net basis, pharmaceutical companies charge Americans 3.5 times as much for drugs as they do in other rich countries, says Breen.
Most large pharmaceutical companies generate between 50pc and 75pc of their revenues from the US, even though typically less than 20pc of their sales volumes are reported there, says Breen.
In some geographies, pharma companies are limited in what they can do on prices. In Australia, for example, prices for medicines are capped. US drug firms have raised this with Trump, claiming such “egregious and discriminatory” policies are hurting their profits.
UK health insiders are also wary that Trump could turn his gaze to how other countries are securing lower prices.
“These other countries are smart,” Trump said on Tuesday. “They say you can’t charge more than $88 otherwise you can’t sell your product and the drug companies listen to them.”
The concern is that this could shine a light on the NHS, which is among the toughest negotiators on medicine pricing. Drug companies are also required to pay sales rebates to the NHS if the health service ends up spending more on drugs than expected.
“Trump could argue that we’re imposing a sort of tariff by grinding down the prices of drugs,” says one senior UK health figure.
US tariffs on imports have been viewed as potentially helping to even the playing field, forcing prices down in America, too.
David Mansdoerfer, the former deputy assistant secretary for health in the first Trump administration, says: “By limiting pharma’s ability to cheaply produce overseas and then mark their prices up in the American market – like they do with insulin – Americans could see a significant benefit.”
However, drug chiefs are concerned that Trump could seek to take a dual approach to tackle the problem, introducing tariffs as well as taking steps to attack their pricing models.
“He’s going to potentially try to whack them with a double header,” says Huynh. “They’re all worried about it.”
Breen says the pharma sector is keeping quiet for now, but claims that inside “these companies, there is a lot of stress testing of their supply chains, of their tax exposures.”
For Trump, pharma is a personal sore spot, having clashed with industry chiefs during his first tenure as president.
As early as 2017, Trump found himself butting heads with industry heavyweight Ken Frazier, then chief executive of drug giant Merck, over the US president’s response to violence in Charlottesville.
Frazier opted to resign from the American Manufacturing Council in protest, fuelling a bitter tirade from Trump on Twitter, where he claimed Frazier “will have more time to LOWER RIPOFF DRUG PRICES!”
In late 2020, during the pandemic, Trump was said to be furious with vaccine chiefs over the slow pace of jab rollouts.
The US president claimed that drugmakers, including Pfizer, sat on positive Covid jab test results until after he had lost the election, writing on Twitter at the time: “They didn’t have the courage to do it before.”
The Food and Drug Administration also came in for a bashing, with Trump claiming the US regulator delayed approvals because it did not want to give him a “vaccine win prior to the election”.
Kate Bingham, who steered the UK’s efforts on Covid jabs, leading the Vaccine Task Force (VTF) in 2020, says the US was “really successful” in its parallel push.
Like the VTF, the US’s Operation Warp Speed was set up at pace in early 2020 to help get Covid vaccines off the ground and, eventually, out to Americans. It was a scheme that was overseen by the Trump administration.
“They were really good at what they did,” says Bingham. “There’s no question that they catalysed the development of vaccines and saved a lot of people’s lives.”
Yet within Trump’s supporter base, it is perhaps not a message that plays well. Instead, among a growing number of these voters, there has been a shift towards vaccine scepticism.
According to figures from KFF, one in four Republican parents now report delaying childhood vaccines. This level has more than doubled since 2022.
Mansdoerfer says distrust in public health, as a whole, “saw a significant increase during the Covid pandemic”.
He says a “significant portion of Trump’s base of support grew alienated from public health” in response to vaccine mandates.
It is a change which Trump has leaned into, not least in his appointment of Robert F Kennedy Jr as his health secretary.
As early as 2005, Kennedy was touting conspiracy theories over vaccines, writing in Rolling Stone and Salon magazines that vaccines were linked to autism in children and scientists and managers were covering it up.
Any link has repeatedly been disproven and the magazines were later forced to delete the article.
However, more recently, Kennedy’s views have been starting to bleed into more mainstream politics.
In a leaked video from a call between Trump and Kennedy last July, during the campaign trail for the US presidency, Trump appeared to agree with concerns over vaccinating children.
He said: “When you feed a baby, Bobby, a vaccination that is like 38 different vaccines, and it looks like it’s meant for a horse, not a, you know, 10-pound or 20-pound baby.”
Last October, during a rally, Trump also suggested he would give Kennedy free rein on healthcare if he secured the presidency, saying: “I’m going to let him go wild on health ... I said he could do it. He could do anything he wants. He wants to look at the vaccines.”
Since then, Kennedy’s views on vaccines have grown increasingly prominent. In Texas and New Mexico, which have been hit with worrying measles outbreaks due to a lack of immunisation, Kennedy has suggested people take vitamin A as a treatment.
In an article for Fox News, the health secretary said that the supplement “can dramatically reduce measles mortality”. Hospitals in Texas recently said they were treating children with vitamin A poisoning.
Sir Andrew Pollard, who helped to create the Oxford Covid vaccine, says the rise in measles in Texas was the “direct result of years of under-vaccination across communities in the state”.
He says the spread of vaccine misinformation is “clearly a risk to the survival of individual children”, while also posing “a wider risk of eroding trust in science”.
Within drug companies, it has created a sense of unease over how decisions are being made in the White House.
Already, the health secretary is on the attack, unveiling plans to ban TV ads for pharmaceutical products over concerns of high US spending on prescription drugs.
Philip Dormitzer, the former chief scientist for viral and RNA vaccines at Pfizer and former head of vaccine research at GSK, says there is a real anxiety over Kennedy: “He does not have a scientific or medical background.”
Dormitzer adds that Kennedy’s views “just don’t stand up to scientific scrutiny, and that makes the environment extremely unpredictable”.
Since taking up his post, Kennedy has gutted the FDA, with insiders suggesting that around a fifth of the agency has been laid off.
Last month, Dr Peter Marks, the top vaccine official at the FDA, was also ousted from his post.
Marks later told the Associated Press that his exit came after he tried to block Kennedy’s team from being able to edit data in the FDA’s mapping database of vaccine side effects.
He told the agency he was concerned that “they’d write over it or erase the whole database”.
Dormitzer says this is a sign of the politicisation of American health policy.
“Fundamentally, there used to be a consensus that decision-making around the regulation of medicines and vaccines should be science-based, not political,” he says.
“That consensus seems to be breaking down right now.”
The cuts at the FDA may chime with the Trump administration’s push to take an axe to government agencies.
Yet they also pose a looming threat to Trump’s ambitions to force more drugmakers to set up more factories in the US.
Pharmaceutical manufacturing sites take five years to build, therefore decisions must be made against a stable political backdrop.
Sir John says it expansion in the US is not something that companies can “immediately do”.
However, there is also a key question over whether it would be the right decision to cave to Trump regardless.
A key reason why the US has such a large trade deficit on pharmaceuticals has come down to cost.
While big pharma focuses on selling high-profile, patented drugs, around 90pc of US prescriptions are either generics or biosimilars – meaning they are drugs that have fallen out of patent and can be made at much cheaper prices.
For these medicines, a large proportion of the ingredients come from India and China.
On ibuprofen, for example, factories in China and India make almost all of the world’s supply of the active ingredient in the drug.
Companies do not make huge margins for these generic medicines, meaning that when costs rise, their prices typically do too.
John LaMattina, the former president of Pfizer global research and development, says he is concerned that companies will have little choice but to pass on higher costs.
“Almost all generic drugs are made outside of the US as generics are much cheaper to import from Canada, India and China than to manufacture here,” he says.
This could pose a major threat to the health of many Americans, he says, who may no longer be able to afford medicines.
“In the US, roughly 10pc of people have no health insurance and thus pay for drugs out of their own pocket,” says LaMattina.
Big pharma, on the other hand, is fearful that tariffs will damage investment across research and development, which is crucial to future growth.
Senior drug leaders are privately alarmed at the direction of travel, yet few want to put their heads above the parapet.
David Ricks, the chief executive of obesity drugmaker Eli Lilly, flew the closest to criticism this month, when he said spending less on research would be “a disappointing outcome”.
It was a rare intervention from someone who struck a more conciliatory tone months earlier.
“My experience, having done this for eight years, is that there’s often more common ground than you’d think,” Ricks said, days after meeting Trump at Mar-a-Lago last December.
Now, it appears that the common ground was, at best, shaky.
A seismic shock is coming for the sector – all pharmaceutical executives can do is brace.
