As big drug companies line up to announce new U.S. jobs and plants in the face of Trump tariff threats, generics giant Sandoz is sending a different message.

The big picture: CEO Richard Saynor is telling the Trump administration it should use carrots, not sticks, with generic drug makers that account for more than 90% of U.S. prescriptions but that compete on price and volume — to a point where, as he puts it, antibiotics sell for less than a packet of M&Ms.

Sandoz makes about 1,300 generic and biosimilar products, some 150 of which are sold in the U.S. With 2024 annual sales of $10.4 billion, it's part of a cohort of generic drug giants that also includes Teva, Sun Pharma and Viatris.

Saynor spoke to Axios about how his message is landing — and the volatility of navigating a second Trump term. The conversation has been edited for length and clarity.

Could tariffs erode your profits enough that you'd pull drugs from the U.S. market?

"The tariffs that we see at the moment, we can absorb. We will manage. If it's a 200% tariff, again, we will think about what we do. The challenge I have is we have relatively few choices. You either say, 'Well, fine, our first primary duty is making sure patients get medicines. Secondly, how do we least make the market sustainable?'"

• He saw reason for optimism in last week's joint U.S.-EU statement that appeared to largely exempt EU generics from duties.

How do you navigate the uncertainty from the tariff threat? What do you tell your board?

• "I see more positives than negatives to be brutally honest. If you take a step back, why is this happening? Why is the administration challenging pharma? Because ultimately, [Trump] wants affordable access of high-quality medicines for U.S. patients. I want the same at the end of the day."

Big brand-name manufacturers are committing huge investments in U.S. manufacturing and jobs. You're not. Why?

"There are very clear choices that people need to make to make sure things like antibiotics are sustainable for generations. For us to build a new antibiotic facility would be $2 billion to $3 billion over five years ... how am I going to convince a board to give me that money?"

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Johns Hopkins hospitals and physicians are officially out of UnitedHealthcare's provider network after they failed to reach an agreement on a contract by a Monday deadline.

Why it matters: The standoff between the health care titans is another example of tension between insurers and health systems amid rising health costs, labor shortages and other pressures.

Driving the news: Hopkins blames the insurer's prior authorization reviews and "aggressive" claims denials it says add red tape and delay necessary care, along with payments for services.

• Johns Hopkins will not sign a contract that "allows an insurance company to put profits over patients' health and well-being," a spokesperson wrote in an email.
• She said the health system is reaching out to the roughly 60,000 UnitedHealthcare patients who received care at its facilities within the last year.

The other side: "Johns Hopkins refused to move off contractual terms no other health system in our network requires, including language that would allow it to deny patient access at its discretion," Joseph Ochipinti, UnitedHealthcare CEO of the Mid-Atlantic region, wrote in an emailed statement.

• Specifically, the insurer says Johns Hopkins proposes the right to refuse in-network care to any self-insured employer who uses UnitedHealth as its third-party administrator. It also wants to make UnitedHealth responsible for claims from former patients who've switched to new carriers.

UnitedHealthcare said patients receiving ongoing care for transplants, pregnancy or cancer can continue to see their doctors at in-network rates and should contact the insurer.

What's next: Both sides said negotiations are continuing.

Almost 2 in 3 physicians say there aren't enough qualified doctors to fill openings in their area, in another sign of how the health care workforce is straining to meet patient demand.

The big picture: Mergers and acquisitions of practices, turnover from pandemic-era burnout and expansion into underserved areas are raising doubts about whether the nationwide shortage of doctors will ease over the next decade, a Medscape survey of 1,001 physicians found.

• More patients may be shifting from clinics to hospitals, increasing demand for doctors, market analysts said.

By the numbers: 63% of respondents said there was a shortage of qualified applicants for physician openings in their area, especially in primary care.

• 30% said the number of qualified applicants for those jobs has declined from three years ago, while 22% believe the quality has risen.

The physicians blamed a variety of factors, from not enough medical school applicants to hospitals' ability to outbid group practices.

Yes, but: The doctors noted an increase in qualified applicants for nurse and physician assistant positions over the prior three years.

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A case of the flesh-eating New World screwworm parasite was detected early this month in a person in Maryland who returned to the U.S. after traveling to El Salvador, HHS said.

Why it matters: It's the first human case of parasitic fly larvae infestation connected to travel from an outbreak-affected country in the U.S, said HHS spokesperson Andrew Nixon, noting the risk to public health in the U.S. is low.

• The USDA in May suspended livestock imports originating from or transiting Mexico, noting the northern progression of the deadly parasitic fly, which burrows into the flesh and feeds on live tissue.

Driving the news: NWS is "typically found in South America and the Caribbean," according to the CDC.

• The USDA estimates that a screwworm outbreak in cattle could cause $1.8 billion in economic damage to Texas alone.
• Maryland health officials said the person had recovered.

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☎️ Fear and confusion among CDC scientists blacked out communications and kept them from helping with an emergency response as measles surged in Texas early this year. (KFF Health News)

💉 Pfizer's COVID vaccine for young children may not be renewed by the FDA this fall, prompting Moderna to fill possible gaps in supply. (The Guardian)

💰 AbbVie is buying a next-generation drug from a psychedelics developer in a deal worth up to $1.2 billion. (Axios)