Pharmaceutical companies often invest billions to develop new drugs, with the U.S. market as a crucial target. The benefits extend globally.

Consider the $11 billion acquisition of Pharmasset by Gilead Sciences more than a decade ago, which led to the development of Sovaldi, a groundbreaking hepatitis C treatment. When Sovaldi was launched in the U.S. at $84,000 for a 12-week regimen, it sparked widespread criticism for its high cost. Policymakers and patient groups slammed Gilead. Yet there was a clear beneficiary from America’s willingness to pay sky-high prices: the rest of the world. Egypt, for example, which at the time had the world’s highest hepatitis C prevalence, got a 99% discount on the drug at the time.

As Donald Trump awaits a return to office, he is likely to revisit his stance that the U.S. is being “ripped off” by other countries. While his first term focused heavily on trade deficits and NATO contributions, his administration also tried to address global drug-pricing disparities through an executive order. The most-favored nation rule, as the executive order was known, sought to link some U.S. drug prices purchased through Medicare to those of other wealthy countries. Though the order was never implemented because of legal challenges, there are indications that Trump might revive similar efforts. Recently, Eli Lilly Chief Executive David Ricks, who dined with Trump at Mar-a-Lago, hinted at the possibility of such initiatives resurfacing.