In this week’s edition of InnovationRx, we look at Trump’s pharmaceutical tariffs, the first robotic cataract surgeries in humans, the underbelly of marketing compounded GLP-1s, and more. To get it in your inbox, subscribe here.

Last week, the Trump administration announced its long-hinted-at tariffs on pharmaceuticals. These include a 100% base tariff on both imported, patented drugs and their active pharmaceutical ingredients.

But there are a lot of exceptions. Generic drugs, many of which are produced in India, are exempt for now, though the administration hinted at potential action in 2027. So are medicines imported from the United Kingdom. Trading partners like Japan and the European Union will face a much lower 15% rate.

Pharmaceutical companies including Pfizer and Eli Lilly that signed Most Favored Nation deals with the Trump Administration, along with promises to bring manufacturing to the U.S., will also escape the new levies. Companies that promise to onshore production without signing an MFN deal will see rates of 20%. A total of 16 big pharma companies fall into those two categories.

The jumble of tariffs are slated to go into effect in 120 days for certain larger companies and in 180 days for smaller firms. Although the Supreme Court struck down some tariffs last month, these tariffs may be on stronger legal ground. That’s because they fall under Section 232 of the Trade Expansion Act of 1962, which provides more Presidential authority to enact import duties.

The Pharmaceutical Research and Manufacturers of America, whose board comprises CEOs of companies like Johnson & Johnson and Merck, issued a statement opposing the tariffs. So did the Biotechnology Innovation Organization, which argued that they’ll hit small and midsized drug companies the hardest. These firms not only lack the capital to onshore manufacturing that bigger players have available, but they also have fewer approved drugs and tighter margins, making it tougher for them to absorb the costs, Beth Snyder Bulik, a healthcare analyst at eMarketer wrote in a research note.

Despite The War, Israeli Startup Performs First Robotic Cataract Surgeries In Humans

ForSight Robotics announced on Tuesday that it had completed the world’s first robotic-assisted cataract surgery in humans. The Israel-based company, which had been testing its machine on pig eyes, completed the procedure on 12 people in the Philippines, with plans to do eight more there before moving on to a larger clinical study in order to get FDA approval.

“I don’t think people understand how fast robotics is coming,” Dr. Joseph Nathan, ForSight’s cofounder and president, told Forbes. “For this to happen, it is a big deal for the industry.”

It’s also a big deal for the Israeli medtech at a time of the U.S.-Israel war with Iran. Nathan said that it wasn’t easy for the Israeli team members to get to Manila and back with the robotic system while missiles were flying.

The first procedures were done on February 26, two days before the war began, and to return home the team flew through Dubai. They were supposed to be there for just a few hours. “It became one week in Dubai because everything shut down, and you get missiles over there as well,” Nathan said. The team eventually was able to travel through Jordan and on to Israel. The next round of surgeries were done in the Philippines in March. “Regardless of what’s happening, we will find a way,” Nathan said. “There is a saying that Israeli tech delivers no matter what.”

Forbes previously wrote about ForSight when it raised $125 million led by Eclipse Ventures with participation from legendary robotic surgery pioneer Fred Moll last June at an estimated valuation of $500 million. The company does not have plans to raise additional funds, despite valuations for robotics startups being “super high right now,” Nathan said. “It’s become very, very hot and popular for VCs that in the past were concentrating on SaaS and software.”

For ForSight, the focus on cataracts is a numbers game. More than 600 million people worldwide are believed to need cataract surgery to replace a clouded lens, yet only 30 million surgeries are performed annually. There’s no way to bridge the gap between that demand and the number of eye surgeons available worldwide without technology. Because cataract surgery is a very quick procedure, as well as a repetitive and bloodless one, it lends itself well to robots. Robotic assistance also makes the surgery faster–and it should get even speedier over time. As Nathan says of the gap: “You need to give surgeons the ability to do more procedures.”

The Underbelly Of Marketing Compounded GLP-1s

Medvi, which The New York Times hailed as the first billion-dollar AI company built by one man (and his brother), shows the underbelly of the drug compounding business. It’s got no doctors or pharmacists on staff yet claims that it will sell $1.8 billion worth of drugs this year, up from $401 million last year. The Times doesn’t mention that the company got a warning letter from the FDA back in February for “false or misleading claims” regarding the compounded GLP-1 weight-loss drugs it’s been hawking–part of a broader FDA crackdown on the industry. Also in question: Why would consumers continue to buy compounded drugs–which are neither FDA approved nor evaluated for safety and effectiveness–now that branded Zepbound and Wegovy no longer face shortages and are increasingly available at more affordable prices?

Deal of the Week

Neurocrine Biosciences agreed to buy rare-disease drugmaker Soleno Therapeutics for $2.9 billion in cash–a substantial premium for Soleno and Neurocrine’s largest deal since it was founded. The big prize for $13 billion (market cap) Neurocrine is Soleno’s drug Vykat XR, the first FDA-approved medication for the insatiable hunger associated with the rare genetic disorder Prader-Willi Syndrome. Soleno logged $190 million in sales from the drug last year following its March approval. In an investor call on Monday, Neurocrine CEO Kyle Gano called Vykat XR “a potential blockbuster in the making.”

WHAT WE’RE READING

Google said that it is adding mental health safeguards to its AI product Gemini.

The Iran war is leading to shortages of medical supplies around the world, with therapeutic foods and other medications stuck in Dubai’s port.

Snake bros keep getting bitten by their lethal pets. America’s zookeepers–and a cooler full of antivenom–are their best chance of survival.

Inside UnitedHealth Group’s $3 billion bet on AI and what it may mean for patients.

In Utah’s next test of AI prescribing, startup Legion Health’s chatbot will be able to renew psychiatric medications.

Seven people share what it’s really like to be diagnosed with cancer under the age of 40.

China’s Syneron Bio raised $150 million for AI-based peptide discovery, just four months after raising nearly $100 million.

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