The following content is sponsored by Americans for Limited Government.

President Trump has never been afraid to say what career politicians won’t: America has been getting ripped off by foreign freeloaders for decades, especially when it comes to prescription drugs. While U.S. patients and taxpayers foot the bill for the world’s most advanced medicines, wealthy nations have been freeloading off our innovation.

Last year, Trump took a major step toward fixing that imbalance by forcing the United Kingdom to come to the table and pay more for breakthrough treatments. Past presidents could only dream of a win that big. Now, it’s time to do the same with Japan.

Let’s be clear about the problem. American companies lead the world in developing lifesaving drugs, from cutting-edge cancer therapies to revolutionary treatments for rare diseases. That innovation doesn’t happen by accident – it requires massive investment, risk-taking, and a regulatory environment that rewards success.

But while Americans pay market-based prices that sustain this engine of discovery, countries like Japan impose socialist-style price controls that undervalue these medicines. The result? U.S. patients effectively subsidize the rest of the world.

That’s not fair. And more importantly, it’s not sustainable.

President Trump understands this better than anyone. His approach to trade has always been rooted in a simple principle: reciprocity. If other countries want access to American goods, markets, and security guarantees, they need to play by the same rules.

The deal with the U.K. proved that this strategy works. By leveraging America’s economic strength, Trump secured commitments that will finally force that group of countries to pay their fair share while reducing the burden on American taxpayers. In the process, he delivered humanitarian relief to U.K. patients who will benefit from greater access to American-made wonder drugs.

Japan should be next.

This isn’t about punishing an ally – it’s about restoring balance. The U.S.-Japan relationship is strong, and recent agreements on technology, AI, and supply chains show just how much both nations can accomplish together. But true partnership requires fairness across the board, including in how we value medical innovation.

If Japan wants to collaborate on the future of biotechnology and pharmaceutical supply chains, it must also be willing to pay prices that reflect the true value of American innovation.

Critics will say this risks trade tensions or higher costs for Japanese patients. That’s the same argument we heard with Europe and the U.K. – and it didn’t hold up. What actually happens when countries pay their fair share is faster access to cutting-edge treatments, stronger collaboration, and a more sustainable global innovation ecosystem. In other words, everyone benefits.

There’s also a national security dimension here that Washington swamp elites often ignore. Pharmaceutical leadership is not just an economic advantage – it’s a strategic one. The ability to develop and manufacture advanced therapies is critical in a world where biological threats are real and growing. Allowing foreign governments to systematically underpay for these innovations weakens the very system that keeps America – and its allies – safe.

President Trump has already shown he can deliver results where others have failed. Taking on Japan over drug pricing would be a natural extension of his America First agenda: standing up for American taxpayers, patients, and innovators while strengthening alliances through tough but fair diplomacy, not timid complacency.

The message should be simple and direct: if you want access to the best medicines in the world, you need to pay what they’re worth. No more free rides. No more excuses. It’s time for Japan to step up and pay their fair share.