Although manufacturing as a whole experienced a modest increase in exports in 2025—only 3.2%—the pharmaceutical sector experienced a 28.5% increase in foreign sales, thereby becoming the primary motor of the Italian industrial sector's performance. The American market was the key engine of expansion. Italian pharmaceutical exports to the United States climbed by 54.1% in 2025, with particularly significant growth in the first seven months of the year—up 73.2%—before slowing in the second half but staying solid. However, Istat emphasizes that multinational corporations account for nearly all pharmaceutical exports and imports. This means that the good sales performance to the United States is mostly due to attempts to reorganize intra-group commerce among multinationals operating in Italy—both Italian and foreign-controlled—rather than organic growth in local pharmaceutical manufacture. In short, the sector's fate is dependent on the strategic decisions of a few significant groups. While exports provide a generally good picture, imports raise numerous questions: in 2025, Italian purchases of pharmaceutical products from China grew by 933.7%, from just over €680 million to more than €7.7 billion.