The Inflation Reduction Act's Medicare drug price negotiation program, sold by Democrats as a way to lower prescription costs, is instead driving up rejection rates for patients and could push prices higher across the broader market, policy analysts say.
Nearly one in four patients who tried to fill a prescription for one of the drugs selected under the program were initially rejected after a new coverage requirement took effect earlier this year, IQVIA data showed. That 24 percent first-fill rejection rate was unchanged from 2025, before the coverage mandate kicked in, suggesting the government's price controls have done nothing to improve patient access.
For the sickest patients, the numbers are far worse. Initial rejection rates hit 67 percent for the selected cancer drugs and 59 percent for immunology medicines. A month after the first attempt, 16 percent of cancer claims and 22 percent of immunology claims still sat in limbo, denied.
The law, signed by then-President Joe Biden in August 2022, authorized the federal government to negotiate prices for certain high-cost prescription drugs covered by Medicare. Congressional Democrats pitched it as a historic win for seniors struggling with drug costs. Four years later, the data tells a different story.
Isabelle Marchese, director of health policy at Americans for Tax Reform, told the Daily Caller News Foundation that the access problems are a direct and predictable result of government-imposed price caps:
"Despite the IRA's drug price controls being sold as a boon to consumers, the policy doesn't actually solve any of the health-policy problems people consider most important to them. Price controls don't eliminate cost or risk; they simply reallocate them in less efficient, less transparent ways. To protect their income, insurers and PBMs have, naturally, responded by tightening their utilization-management tools, prior authorization, quantity limits, formulary exclusions, and/or preferred-status restrictions, on the drugs whose list or net prices have been artificially suppressed."
In plain English: when the government forces drug prices down on paper, insurers and pharmacy benefit managers, the middlemen who manage prescription coverage, make up the difference by putting more barriers between patients and their medications. More paperwork. More hoops. More denials.
A survey published in March by No Patient Left Behind found that 92 percent of Medicare beneficiaries expect to face higher out-of-pocket costs under the IRA. Thirty percent said their Medicare Part D plan initially denied them access to a drug their doctor prescribed.
Those are not fringe complaints from policy wonks. Those are seniors reporting that a law sold as a lifeline is making it harder to get the medicines their physicians ordered.
Sally Pipes, president and CEO of the Pacific Research Institute, pointed to the IQVIA rejection data as proof that the program is failing on its own terms:
"The IRA was sold as a way to make medicines more affordable and accessible, yet nearly one in four patients trying to start one of the first 10 price-controlled drugs was initially denied. For some of the sickest patients, the rejection rates were much higher. Initial rejection rates reached 67% for the selected oncology medicines and 59% for the immunology medicines, according to IQVIA data. Even a month after the initial attempt, 16% of oncology claims and 22% of immunology claims remained rejected."
Pipes said the data shows that "government price controls have a negative impact on improving patients' access to medicines." She warned that denial rates and utilization management will likely keep rising as the IRA's price controls expand to cover more drugs each year.
But Pipes reserved her sharpest criticism for the law's long-term consequences. The IRA, she argued, "is not delivering the outcomes that Democrats promised", and is actively deterring pharmaceutical companies from investing in medical research and development, a cost that Americans will pay in fewer breakthrough treatments down the road.
The Trump administration has separately moved to rein in ballooning Medicare Part D costs inherited from the Biden era, ending a subsidy program after the Congressional Budget Office revealed its price tag had exploded by hundreds of billions.
Marchese laid out a cascade of consequences she said the price controls will trigger, not just for Medicare patients, but for the majority of Americans under 65 who get coverage through private employer plans:
"Not only will these price controls cause drug price hikes and limit access in the near future, but the long-term effects of this policy are even more devastating. In the near term, companies will raise launch prices on new drugs, accelerate price increases on non-selected products, and shift costs onto the commercial market that covers the majority of Americans under 65. In the long term, many of the high-risk, high-reward research projects that made the U.S. the world leader in biomedical innovation will never be started."
The argument is straightforward: squeeze drug companies on one set of prices, and they raise prices everywhere else. Seniors may see a lower sticker on a handful of drugs, if their insurer lets them fill the prescription at all, while working-age Americans absorb the cost shift through higher premiums and drug prices on the commercial market.
Marchese called the access problems "inevitable consequences of price controls," adding that they "never make the underlying costs or risks disappear, they only force someone else (often, patients) to absorb them through more red tape, delayed care, and restricted access."
Broader questions about transparency in drug regulation have also gained traction in Washington, with the FDA proposing mandatory ingredient disclosure rules as part of the administration's health agenda.
The Centers for Medicare and Medicaid Services, the federal agency running the negotiation program, released a proposed rule in June to lock in regulations governing the program for 2029 and beyond. CMS plans to finalize that rule this fall and submit revised data-collection requests to the Office of Management and Budget for approval.
A CMS spokesperson defended the program in a statement, saying the agency "is focused on delivering lower prescription drug costs for seniors while protecting taxpayers and preserving access to innovative treatments." The spokesperson added that CMS "is closely examining emerging cost trends and using every available tool to promote affordability, competition, transparency, and responsible stewardship of taxpayer dollars."
"This includes doubling the amount of estimated savings in the second year of the Medicare Drug Price Negotiation Program. The Administration is committed to building a Medicare drug program that puts American patients first, securing better value, strengthening accountability across the system, and ensuring seniors have access to the medicines they need at prices they can afford."
CMS did not explain how it defines "doubling" its estimated savings or provide baseline figures. The White House did not respond to a request for comment.
Former Trump Domestic Policy Council Director Joe Grogan has previously called the administration's savings claims into question. Grogan called the $6 billion savings figure "totally bogus" and "a made up number" because it compared negotiated prices to list prices rather than the real-world costs that pharmacy benefit managers had already negotiated down. The Pharmaceutical Care Management Association found that PBM negotiations had already secured deeper discounts on six of the ten drugs CMS selected, raising the question of whether the government program was redundant from the start.
Rep. Greg Murphy, a North Carolina Republican and physician, posted on X in July that "access to care and critical drugs will be crushed" by the IRA's negotiation program. Murphy said he is working on a bipartisan effort to reverse what he called the law's "short-sighted reimbursement formula."
The political landscape around drug pricing is complicated. A September 2024 KFF poll found that 85 percent of voters supported letting the federal government negotiate drug prices for Medicare enrollees, a figure that crossed party lines. But support for the concept does not mean the IRA's specific mechanism is working as advertised.
The Paragon Health Institute pointed to a Health Affairs analysis arguing that private plans were already successfully negotiating drug prices without government price controls, suggesting the IRA's heavy-handed approach was a solution in search of a problem.
President Trump signed an executive order in May 2025 aimed at broadening Americans' access to "most-favored-nation" pricing for prescription drugs. Some experts have compared that approach to its own form of price controls, though the mechanism differs from the IRA's direct negotiation framework.
Meanwhile, other corners of the administration's health policy agenda have moved forward on separate tracks, including new drug screening programs for active-duty military personnel.
The gap between what Democrats promised and what the IRA has delivered keeps widening. Supporters said seniors would pay less. Instead, nearly a quarter of patients trying to fill prescriptions for the program's selected drugs get turned away on the first try. Cancer patients face a 67 percent initial rejection rate. Immunology patients face 59 percent.
Supporters said the program would make drugs more accessible. Instead, insurers responded to squeezed prices by erecting new barriers, prior authorizations, quantity limits, formulary exclusions, that fall hardest on the patients who need these drugs most.
And supporters said the program would save taxpayers money. But CMS cannot clearly explain its own savings figures, the White House will not answer questions about the program, and independent analysts say the claimed savings are built on misleading comparisons to list prices that nobody was actually paying.
CMS is pressing ahead anyway, preparing to finalize rules that will expand the program to more drugs in 2029 and beyond. Every expansion means more drugs subject to the same price-control dynamics that are already producing rejection rates and access barriers the law was supposed to eliminate.
Price controls have never repealed the laws of economics. They just move the bill to someone who cannot fight back, and in this case, that someone is a senior at the pharmacy counter, being told the government negotiated a great deal on a drug their insurer will not let them have.
