“Other nations have been freeloading on US innovation for far too long; it is time they pay their fair share,” he wrote, giving firms until September 29 to commit to the goals.

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If drugmakers refuse to step up, the administration will “deploy every tool in our arsenal” to end “abusive drug pricing practices”, he wrote.

It was not immediately clear how Trump’s instructions would intersect with the PBS more broadly. Treatment of pharmaceuticals is already managed under the US-Australia free trade agreement.

Trump has also pledged to impose 200 per cent tariffs on imports of pharmaceuticals, which would hit more than $2 billion a year in Australian drug products. The Australian government said in early July it was seeking more detail on the plan.

American drugmakers have long harboured other gripes against the PBS, including that it restricts market access for non-listed products, or undervalues innovative products.

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An industry lobby group, Pharmaceutical Research and Manufacturers of America, identified the PBS on a list of “egregious and discriminatory” policies in a submission to the US Trade Representative this year, saying it threatened market competitiveness.

A spokesperson for Health Minister Mark Butler said the government would not negotiate over the future of the PBS.

“Our government is getting on with the job of delivering cheaper medicines for Australians,” they said.

“The PBS is not up for negotiation.”

Trump’s latest pharmaceutical missive comes as he prepares to sign executive orders within hours that will set new tariffs on the US’s major trading partners, including a potential increase to the “baseline” tariff rate of 10 per cent, currently applied to imports from Australia.

Trump has said the rate was likely to rise to 15 or 20 per cent, but the Australian government has been kept in the dark about whether that would also apply to Australia.

“Those discussions are taking place with the trade team today,” White House press secretary Karoline Leavitt said on Thursday in Washington, referring to tariff rates for countries that had not signed a deal with Trump.

“The answer to that question will be in the executive order … I won’t get ahead of the president on that baseline,” she said.

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Leavitt said the president was fielding phone calls from world leaders and there was still time for a trade “deal” to be struck before midnight in Washington, ahead of the tariffs going into effect on Friday.

Meanwhile, a legal challenge to most of Trump’s tariffs was heard in an appeals court on Thursday, Washington time, brought by a number of small businesses including a New York-based wine importer.

In May, the Court of International Trade in Manhattan found Trump’s so-called reciprocal tariffs were unlawful because the president lacked the authority to impose them using emergency powers.

Appeal judges appeared unconvinced during Thursday’s appeal. “[The emergency powers law] doesn’t even mention the word ‘tariffs’ anywhere,” Circuit Judge Jimmie Reyna said, in a sign of the panel’s incredulity to a government attorney’s arguments.

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Trump thanked his lawyers and wished them well ahead of the hearing. “Tariffs are making America GREAT & RICH Again,” he posted on TruthSocial.

“They were successfully used against the USA for decades and, coupled with really dumb, pathetic, and crooked politicians, we’re having a devastating impact on the future, and even the survival, of our country. Now the tide has completely turned, and America has successfully countered this onslaught of Tariffs used against it.”

Australia has no tariffs on US imports, and the Australian government has maintained a fair deal with Australia would involve zero US tariffs.

With AP, Brittany Busch