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Yes, drug prices can be lowered without proving that medical innovation must collapse—but no policy can promise lower prices with zero effect on research incentives. The practical question is how to reduce costs while limiting avoidable harm to research, access, and competition. Congressional Budget Office (CBO) estimates show that different policies can produce very different price effects, and its forecasts of innovation effects remain uncertain rather than observed counts of lost medicines.
What “lower drug costs” can mean
Drug prices, patient bills, and public spending are related but distinct measures. A lower negotiated or net price for a medicine does not automatically mean every patient pays less at the pharmacy, and a change in federal spending does not by itself establish whether patients can afford or obtain treatment. Any comparison should specify which price or cost is changing, who is affected, and over what period.
CBO’s October 2024 analysis estimated average U.S. retail prescription-drug prices after rebates and discounts. Its projections compare modeled policies with then-current policy and cover brand-name, generic, and biosimilar medicines in 2031. They are not observed savings, guarantees, or estimates of the reduction for every medicine.
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CBO examined policies that work through different parts of the market. The estimates below are modeled average-price effects for 2031; the drug-specific effect can be larger or smaller.
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| Policy approach | Modeled 2031 price effect | What changes, and what to keep in mind |
|---|---|---|
| Set maximum prices using prices in high-income foreign countries | CBO estimated average U.S. retail prescription-drug prices could be reduced by more than 5%. | The model depends on foreign prices. CBO cautioned that manufacturers could respond by changing prices or availability in foreign markets. |
| Negotiate prices for additional Medicare drugs each year | CBO estimated average drug prices could fall by 0.1% to 3%, depending on the modeled scenario. | For additional drugs newly negotiated under one modeled policy, CBO estimated Part D net prices could be 25% to 40% lower. The average-market change is more modest because those medicines represent a minority of total spending. |
| Extend Medicare-negotiated prices to commercial purchasers | CBO estimated average drug prices could fall by 1% to 3%. | The extension reaches beyond Medicare, and its overall effect depends on which purchasers and medicines are involved and how market participants respond. |
| Increase competition or improve price information | Not stated as a comparable average-price estimate in CBO’s October 2024 analysis. | These approaches address different market conditions; CBO’s inclusion of an approach does not signify endorsement. |
The estimates are not interchangeable: the foreign-reference estimate is an average across the retail market, while the 25% to 40% estimate applies to Part D net prices for a particular group of newly negotiated medicines in one modeled expansion. CBO also notes that negotiation can affect prices for selected drugs and therapeutic competitors in Part D and Medicaid; extending negotiated prices to commercial buyers can influence negotiated prices and prices in other market segments.
What the Inflation Reduction Act does—and what its budget update says
The Inflation Reduction Act (IRA) combines several provisions that should not be treated as one price-control measure. It authorizes negotiation for selected high-expenditure drugs, provides inflation rebates when certain prices rise faster than inflation, and redesigns the Medicare Part D benefit by capping annual enrollee out-of-pocket spending and shifting more financial liability to plans and manufacturers. Negotiation, rebates, and benefit redesign can affect different prices, payers, and spending totals.
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In July 2026, CBO reported that spending reductions from negotiation and inflation rebates had been smaller than initially estimated, while costs from the Part D redesign had been substantially larger than anticipated. CBO then projected that the provisions together would increase deficits over 2022–2031. That is a revised federal budget projection; it does not show that negotiated prices had no effect, settle the question of patient affordability, or measure the IRA’s long-run effect on new medicines.
Why price reductions can affect medical research
Drug development depends in part on the revenue a company expects to earn if a medicine succeeds, weighed against the cost and risk of research. CBO’s October 2024 analysis describes the basic tradeoff: policies that reduce manufacturers’ expected revenue or raise their investment costs can weaken incentives to conduct research and development (R&D), slowing the pace of pharmaceutical innovation. That mechanism is real, but its size depends on how a policy changes expected returns across medicines and markets.
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Prices are not the only influence on those returns. CBO identifies exclusive sales rights under patent and Food and Drug Administration approval rules, insurance coverage and market-segment characteristics, and competition from drugs with similar clinical effects as price determinants. Exclusivity periods vary, and therapeutic competitors may constrain pricing. Consequently, the effects of a price policy can differ by drug, by the competition it faces, and by the portion of its sales exposed to the policy.
What is known about possible effects on new medicines
A CBO 2022 estimate, reported by the Congressional Research Service (CRS), projected that the IRA would result in about one fewer drug introduction in 2023–2032, about five fewer in the following decade, and about seven fewer in the decade after that. These are forecasts, not a count of medicines already shown to be missing, and they do not identify the clinical value of any projected reduction. CRS notes that the full effects may take years to emerge as more drugs become eligible.
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The estimate therefore supports neither “innovation is unaffected” nor “a known set of important treatments will be lost.” It illustrates a possible long-run incentive effect whose magnitude remains uncertain. CBO’s July 2026 budget update does not replace that innovation forecast: budget savings and costs are not a direct measure of research activity or future drug introductions.
How to judge whether a policy strikes a sensible balance
A credible assessment should ask who gains, who bears the costs, and what happens to research and access—not rely on a single average price or federal budget number.
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- Which price is changing? Distinguish list prices, negotiated prices, net prices after rebates, and patients’ out-of-pocket costs.
- Which buyers and medicines are covered? Medicare, Medicaid, commercial insurers, and cash-paying patients may experience different effects. A change affecting a limited set of high-spending drugs can have a larger effect on those drugs than on the market-wide average.
- How might other participants respond? Manufacturers, insurers, and purchasers can change prices, coverage, availability, or purchasing behavior; CBO’s estimates are modeled outcomes, not guarantees that behavior stays fixed.
- What are the effects on competition and access? Consider therapeutic alternatives, exclusivity, availability across markets, and whether patients can obtain the medicines they need.
- What evidence would show an innovation effect? A budget estimate or a forecast of fewer introductions is not the same as observing which research projects changed, which medicines reached patients, or the clinical value of those medicines.
The practical answer
America has multiple policy levers that can reduce prescription-drug prices, but their savings differ by design, purchaser, and medicine. CBO’s modeled 2031 estimates show that market-wide savings can coexist with larger reductions for particular negotiated drugs. The same evidence also supports a genuine concern that lower expected returns could weaken R&D incentives, while leaving the scale and long-run consequences uncertain. The defensible goal is not to promise innovation will be untouched; it is to weigh affordability, access, competition, public spending, and research incentives together when choosing and evaluating each policy.
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