Shares of European drugmakers fell after President Trump sent letters to major pharmaceutical firms urging them to cut drug prices in the U.S. This comes as the sector faces potential tariffs from the U.S.-EU trade deal, with estimates of up to $19 billion in annual costs. Novo Nordisk’s shares plunged 4% following a profit warning and CEO change, wiping out $70 billion in market value. The European healthcare index dropped 0.7%, hitting its lowest point since April.

Trump called on 17 drugmakers to offer most-favoured-nation prices to patients in Medicaid and guarantee such pricing for new drugs. European drugmakers like Sanofi, AstraZeneca, GSK, Merck KGaA, and Novo Nordisk saw their shares fall between 1% to 4%. Novo Nordisk’s shares partially recovered after reports that the U.S. may pilot coverage of weight-loss drugs under Medicare and Medicaid. Rival Eli Lilly’s shares rose nearly 2% in premarket trading.

Pharmaceutical companies have until September 29 to respond to Trump’s demands. U.S. companies like Pfizer, Johnson & Johnson, Eli Lilly, and Merck also received letters. U.S. drugmakers like Merck, J&J, Gilead, AbbVie, and Pfizer saw marginal declines in premarket trading. Analysts believe it’s unlikely the companies will comply with Trump’s request to lower U.S. prices, citing legal and execution challenges.

Trump’s executive order in May instructed drugmakers to align U.S. prices with other countries, prompting some companies to consider new strategies. Swiss drugmaker Roche is exploring the direct sale of prescription medicines in the U.S. to reduce costs for patients. Companies like Pfizer, AbbVie, and Merck KGaA’s U.S. division, EMD Serono, expressed willingness to collaborate with the Trump administration on pricing issues.

Read more at Yahoo Finance: European drugmakers fall after Trump raises stakes over US drug price cuts