The "Use Sovereignty To reduce Rx Act," or USTRx Act, seeks to combat international trade practices by high-income countries that unfairly exploit pharmaceutical innovation, especially those developed in the United States. Congress finds that foreign pharmaceutical price controls distort global trade, depress drug prices, and diminish incentives for new medical discoveries, ultimately shifting development costs to U.S. patients and taxpayers. The bill emphasizes the critical need for the U.S. to use all available trade tools to ensure foreign regulatory reimbursement regimes are transparent, fair, non-discriminatory, and provide full market access for U.S. products. A central provision of the bill is the establishment of a Chief Pharmaceutical Trade Negotiator within the Office of the United States Trade Representative (USTR). This new negotiator will be responsible for conducting trade negotiations, enforcing agreements related to U.S. pharmaceutical products, and actively addressing policies in high-income countries that adversely affect market access for U.S. manufacturers. The negotiator is tasked with being a vigorous advocate on behalf of United States manufacturers and consumers of pharmaceutical products. Furthermore, the USTR, acting through this new negotiator, must annually compile a list of high-income countries and publish a detailed report. This report will review each country's pharmaceutical trade practices, assessing whether they are non-market-based, deny reciprocal market access, or diminish innovation incentives. If adverse practices are identified, the USTR is required to submit a plan to Congress within 30 days, which may include initiating investigations under Title III of the Trade Act of 1974 to address these unfair trade practices.