Medicare Drug Pricing Must Not Create New Barriers for People Living with Chronic Disease

January 28, 2026 (Washington, D.C.) The Partnership to Fight Chronic Disease (PFCD) released the following statement in response to the Centers for Medicare & Medicaid Services (CMS) announcement of 15 new drugs selected for price-setting in Initial Price Applicability Year (IPAY) 2028:

“Prescription medicines are a cornerstone of chronic disease management for Medicare beneficiaries, the vast majority of whom rely on one or more medications every month to maintain their health, independence, and quality of life. As CMS moves forward with the Medicare Drug Price Negotiation Program, it is essential that efforts to lower government costs do not unintentionally restrict beneficiary access to medicines or undermine continued innovation for medicines that treat chronic conditions.

“PFCD remains concerned that this program risks creating new barriers to care through increased utilization management practices, overly broad drug definitions, and insufficient safeguards against discriminatory value metrics. The Inflation Reduction Act (IRA) did nothing to address the role of pharmacy benefit managers, and CMS has refused to take action to protect patient access to price-set medicines. Coverage alone does not guarantee access. Step therapy, prior authorization, and formulary restrictions already delay or deny medically appropriate treatment, and the lack of CMS oversight may cause these insurer behaviors to increase as this program continues.  

“Further, the IRA flat out ignores clinical realities and threats to innovation. Over the past several years, we have seen the impact that this law has had on the research and development of small molecule medicines, which are essential to the treatment of many chronic diseases and often preferred by seniors for their ease of use and accessibility. The earlier price-setting timeline for small molecule medicines continues to be a significant disincentive for investment. In this round of IPAY drug selection, six of the 15 medicines would not have been eligible had the small molecule penalty of the IRA been fixed. For that reason, we again call for Congress to support and pass the bipartisan EPIC Act (H.R. 1492/S.832).

“PFCD urges CMS to strengthen beneficiary and caregiver engagement, enhance transparency around how patient input informs decision-making, and work proactively to prevent unintended consequences that could limit access, exacerbate disparities, or chill research into unmet medical needs. We stand ready to work with policymakers to ensure Medicare drug pricing policies protect patient access, reflect real-world clinical care, and support a health care system that prioritizes better health outcomes while responsibly managing long-term costs.”