Under the Pharmaceutical Zero-for-Zero Initiative, which entered into force in 1995, the United States and its major trading partners eliminated tariffs on many pharmaceuticals, their derivatives, and certain chemical intermediates used to make pharmaceuticals. The . list of pharmaceutical products and chemical intermediates that are eligible for duty- free treatment under the agreement is presented in the Pharmaceutical Appendix to the Harmonized Tariff Schedule of the United States. This appendix is periodically updated to provide duty relief for additional products of this kind, including newly developed pharmaceuticals. This report provides advice on the fourth update to the agreement, in which approximately.