In January 2005 Australia implemented the Australia–United States Free Trade Agreement (AUSFTA). The agreement had placed domestic health policy and the Pharmaceutical Benefits Scheme (PBS) in particular, on the trade negotiating table. At the time Australians were told the PBS would not be undermined, but why was it included in a trade agreement? This article argues that recent reforms to the PBS partially delivered on an issue that the US has compelled its trade negotiators to ensure since 2002: the elimination of reference pricing. In Australia, reference pricing, as used by the PBS, had been credited with obtaining money when buying new medicines.