IRA Drug Price Negotiations to Have Far-Reaching Consequences on Health Care System | Asembia 2025
The Inflation Reduction Act's drug price negotiations could lead to reimbursement complexities, potential pharmacy closures, and reduced patient access to medications, particularly specialty drugs.
The Inflation Reduction Act's (IRA) drug pricing negotiations are poised to dramatically reshape pharmaceutical pricing, patient access, and health care delivery, with effects that could impact the entirety of the health care system in unintended ways, according to a session at Asembia’s AXS25 Summit. John Beardsley, senior vice president of corporate strategy and business development at CoverMyMeds, led a conversation with Fauzea Hussain, vice president of public policy at McKesson, and Ashwin Singhania, partner and principal at Ernst and Young, to discuss the potential impacts of IRA price negotiations.1
The Inflation Reduction Act's drug price negotiations could lead to reimbursement complexities, potential pharmacy closures, and reduced patient access to medications, particularly specialty drugs. | Image Credit: Kenishirotie - stock.adobe.com
Singhania stated that the first and second rounds of drugs under negotiation have different implications for the health care system.1
“[The] drugs that were selected in the first round, it was kind of 7 out of 10 of them were retail drugs [that] at least half a million patients apiece [are taking], in terms of [Medicare] Part D,” he stated.1 “In the second round, 9 out of the 15 are actually more specialty medications [with] less than 30,000 patients here.”
Some patients have enrolled in smoothing programs, which are programs under Medicare Part D that allow patients to spread their out-of-pocket costs for covered prescription drugs over the course of the year instead of upfront at the pharmacy. For pharmacies, this can pose a challenge for a subset of patients starting January 2026 when the first round of drug negotiations begins.1,2
“If any of those patients have 1 of 10 drugs, you have an entirely different way where you are getting reimbursed for 10 drugs compared to the hundreds that you keep in inventory. So, it's going to get very confusing,” Singhania said.1
In another session at the Summit, experts also discussed the unintended consequences of the IRA, stating that pharmacies cannot rely as much on reimbursements as they will be delayed from the pharmacy benefit managers.3
Hussain added that pharmacies might be overburdened by the changes in finances, which can cause pharmacy closures or pharmacies not carrying and dispensing these medications, which makes access more vulnerable. Another added consequence could be a more limited formulary, which will minimize choices and access for patients.1
“There's also the choice side of the equation, right? And [it] can be a physician's choice. It could be patient choice,” Singhania said.1 “How are the formulas going to evolve? Are the negotiated products actually going to be penalized on the formulary? Are they going to be prioritized here?”
He stated no matter the choice, it will result in less access to medications. One example is with obesity medications. There is a huge pipeline for potential glucagon-like peptide-1 (GLP-1) medications, which in theory would increase access. However, semaglutide—as a molecule, regardless of indication—is on the price negotiation list for 2027. Whether the product gets prioritized or penalized, it will affect the uptake of the upcoming products in the pipeline, as many patients might not have access to them at launch.1
“I always say that the unintended consequences of patients are sometimes what's lost in things, and we're doing this to try to make things better for patients,” Hussain said.1 “We have to look at sort of the totality of how we're shifting the health care delivery, not just the price of one product and one item.”
Hussain also discussed treatment for patients. She said that some patients, especially patients with cancer, might want to get treatment where they feel most comfortable. That can be in their physician’s office, with their care team, with their nurses, or with their friends, but with the added pressure on community providers in particular to continue to provide these drugs and these services, there might be a shift in sites of services or other settings, which impacts the patient’s choice in the matter.1
“In a world where you have to have greater operational efficiency, you wind up creating centers of excellence in isolated geographies, and you end up having to make patients travel for care, and so again, unintended consequences of overfocusing on price, as opposed to a combination of pricing and quality,” Beardsley said.1
Read More of Our Coverage: Asembia Specialty Pharmacy Summit
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