Issues - Voters For Cures

The Pill Penalty

Inflation Reduction Act (IRA)

A flawed policy in the Inflation Reduction Act known as the “pill penalty” will have unintended consequences for patients, caregivers and providers for years to come.

The Pill Penalty

Don’t take options off the table: fix the pill penalty!

A flawed policy in the Inflation Reduction Act known as the “pill penalty” will have unintended consequences for patients, caregivers and providers for years to come.

Why is this a problem?

The pill penalty discourages researchers from developing these medicines simply because they come in pill form – already, investments in these medicines have dropped 70%. _[1]
In the long run, the pill penalty will reduce treatment options and make medicines harder to get for patients.
The pill penalty is expected to lead to higher out-of-pocket costs for seniors as PBMs and insurers, who make less money off price-set medicines, are planning to adjust their coverage policies to make beneficiaries pay more. _[2]

The pill penalty ignores the fact that small molecule medicines are crucial tools in fighting many diseases.

Because pills are relatively easier to take than a shot or injection, they are often the preferred method among patients because they offer greater flexibility, affordability and convenience in managing their condition. They are also essential in the treatment of many conditions like:

Cancer
Cardiovascular disease
Mental Health disorders

Small molecule medicines are what people might imagine when they first think of a medicine, they picture a pill, but they also come in a variety of dosage forms like:

Drops
Creams
Ointments
Nasal Sprays
And more

The pill penalty misses the mark for actually lowering patient out-of-pocket costs.

The pill penalty fails to address the root causes of high out-of-pocket costs for seniors –– pharmacy benefit managers (PBMs) and insurance companies who ultimately determine how much patients pay at the pharmacy counter. Despite playing no role in the research or development of medicines, these middlemen take a significant share of every dollar spent on prescription drugs, all while standing in the way of patients and their medicines and denying access to low-cost alternatives. To truly address the issue of rising health care costs, we must hold middlemen accountable not declare a war on cures.

A bipartisan solution to the pill penalty

A bipartisan group of lawmakers in Congress has sponsored a fix to the pill penalty that would ensure patients have continued access to innovative, low-cost, convenient medicines for years to come. The Ensuring Pathways to Innovative Cures (EPIC) Act would align the timeline for eligibility for price setting for small molecules with the timeline for biologics, leveling the playing field for innovation.

The EPIC Act is a critical step toward fixing the pill penalty and ensuring that small molecule medicines remain a viable and accessible treatment option for millions of Americans. By passing this bipartisan legislation, Congress will protect patient access to innovative, affordable treatment options and reaffirm our nation’s leadership in medical innovation.

REFERENCE:

The Inflation Reduction Act’s Impact upon Early-stage Venture Capital Investments
Duane G. Schulthess, Gwen O’Loughlin, Madeline Askeland, Daniel Gassull, Harry P. Bowen
medRxiv 2025.01.07.25320113; doi: https://doi.org/10.1101/2025.01.07.25320113
Magnolia Market Access. Inflation Reduction Act Payer Insights Report. Summer 2024. Accessed February 18, 2025. www.magnoliamarketaccess.com/wp-content/uploads/MMA_IRA-Payer-Insights-Survey4.0_Chartbook_2024.07.31.pdf

Fix the Pill Penalty Because Families Like Mine Need Innovative Medicines