The USTRx Act would create a new senior U.S. trade official—the Chief Pharmaceutical Trade Negotiator—within the Office of the United States Trade Representative (USTR). This official would lead negotiations, enforcement of trade agreements, and actions to address foreign government practices in high-income countries that allegedly unfairly exploit U.S. pharmaceutical innovation by straying from market-based policies. The bill also requires an annual report, through the Chief Pharmaceutical Trade Negotiator, listing high-income countries and evaluating their pharmaceutical policies against several criteria (e.g., fairness, market-based pricing, reciprocal access, and impact on U.S. innovation). If a country’s practices meet these criteria, the USTR must submit a plan within 30 days outlining potential responsive actions, including possible investigations under the Trade Act of 1974. In essence, the bill formalizes a dedicated role and a monitoring/reporting framework aimed at countering foreign price controls and other practices that the sponsor says undermine U.S. pharmaceutical innovation and shift costs to American patients. The proposed actions could lead to investigations and trade remedies if adverse practices are found.