The substance that directly attacks the problem a medication aims to solve is called the active pharmaceutical ingredient (API). China produces 40 percent of the world’s APIs, making it likely that one of the medicines in your cabinet has Chinese ingredients.
The next stop is India, which produces a third of the world’s medications and is the second-largest exporter of drugs to the United States. India is a frequent provider of binders and fillers—ingredients that hold a pill together and give it shape. One example is lactose, which binds ingredients tightly and bulks up a pill to make it easier to swallow.
After the medication is assembled, packaging occurs in Germany, which is currently the largest source of the United States’ packaged medications imports—constituting nearly 20 percent.
Last, the supply chain ends where it started, with distribution and consumption in the United States. Through a process involving wholesale distributors that purchase drugs from manufacturers and send them to pharmacies, hospitals, and elsewhere, a medication eventually makes its way to your medicine cabinet.