The Inflation Reduction Act seems to be sticking around under the new Trump administration, but potential reforms could be coming. One target is a provision of the law that subjects small molecules to pricing negotiations earlier than other medicines.Currently, the IRA makes small molecule drugs eligible for price cuts nine years after approval, while biologics have 13 years before theyre affected. Critics of the rule, including the industry lobbying group PhRMA, call the difference the small molecule penalty, claiming it discourages development of these medications.Late last month, Congress reintroduced a bill known as the Ensuring Pathways to Innovative Cures Act, or EPIC,that would equalize the eligibility period between small molecule drugs and biologics. The same bill was crafted last year and never make it to a floor vote, but this time a different political party holds the congressional majority.The most notable thing is Republicans being in control, said John Stanford, executive director of Incubate, a lobbying coalition for venture capitalists that has tracked the impact the IRA has had on investment. Republicans understand this and aren't scared, from a political standpoint, to fix this.Unlike last year, there is also Senate bill to match the House bill. Incubate is pushing it to be wrapped in Republicans reconciliation package in 2025, which would put any review alongside a number of other Trump administration priorities, such as funding cuts for government agencies.Investment impactMedicare will begin paying negotiated prices for the first 10 drugs in the program in 2026 and, in January, the agency revealed the next 15 medicines up for negotiations in 2027.According to Incubate, the prices and drugs selected have already deterred small molecule investments and led some biotechs to switch gears on their R&D programs. The group reported that 44 research programs and 23 drugs have been discontinued as a result of the IRA.The industry, for better or worse, sometimes is accused of crying wolf, and innovation is ending and the sky is falling, Stanford said. We have chronicled deals, earnings calls, SEC filings, where a company has said, I am shutting down this small molecule because of the IRA.Still, companies making cuts face business challenges beyond the scope of the IRA, so the extent to which the law has forced their hand isnt always clear.Many of the companies listed on Incubates investment tracker are small biotechs, including Boston-based Kojin Therapeutics, which was developing small molecule oncology and immunology drugs before announcing it was winding down operations last month due to insufficient funding. The company noted a lack of investor interest in funding early-stage companies in general, not just small molecule R&D.And Kojin isnt the only drug company facing financial trouble. Many private and publicly traded biotechs have had trouble raising funds during a prolonged downturn, making layoffs and strategic resets a fairly common occurrence over the last few years.Incubate pointed to instances over the last year in which pharmaceuticals companies like Pfizer, Bristol Myers Squibb and Roche, too, have cut small molecule programs and related research.Yet executives of companies affected by the initial round of price talks have largely downplayed the financial impact, at least in the short term. Bristol Myers CEO Christopher Boerner noted that the company will be able to withstand the final negotiated price of its blood thinner Eliquis, while an Amgen executive minimized the inclusion of Enbrel. A handful of studies have also found that claims of innovation being squashed are exaggerated.Stanford, though, countered that the IRAs impact will grow as more drugs are added to the program.On one product at a massive manufacturer, you can manage the impact. Absolutely,“ he said. The first set of drugs being picked had the benefit of being pretty old drugs that were basically losing exclusivity anyway, and many of them had actually already seen competition drive down the cost. '