The Tool Desk
Outbyte Driver Updater FREEScan for outdated or missing drivers - takes under a minuteDriver Scan →Outbyte PC Repair FREEClear out junk files and repair common Windows errorsFree Scan →Yes, drug prices can come down without proving that medical innovation must collapse—but no policy can guarantee lower prices with no effect on research incentives. The outcome depends on which prices fall, who pays less, how manufacturers and insurers respond, and whether the change reduces expected returns on future medicines. Congressional Budget Office (CBO) estimates point to potential savings under several approaches, alongside a real but uncertain risk to research and development (R&D).
What does “lower drug costs” mean?
Drug prices, patient bills, and public spending are related but different measures. A manufacturer’s list price is not the same as the net price after rebates and discounts. Nor does a lower net price automatically mean that every patient pays less at the pharmacy: what an individual pays depends in part on insurance coverage and benefit design.
CBO’s October 2024 analysis modeled average net retail prices—after rebates and discounts—across brand-name, generic, and biosimilar medicines. Its estimates compare specified policies with then-current policy and project results for 2031. They are not observed savings, a forecast of every patient’s bill, or estimates of federal budget effects.
That distinction matters when weighing a policy. A change can lower the price of selected medicines substantially while barely moving the average across the whole market. It can also shift costs among patients, insurers, manufacturers, and public budgets rather than reducing each party’s costs in the same way.
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Which policies could lower prices, and by how much?
CBO examined approaches that work through different parts of the market. The figures below are CBO’s modeled average U.S. retail-price reductions in 2031 under the specified approaches; they are not guarantees or results already achieved.
| Approach | How it works | Modeled average-price effect |
|---|---|---|
| International reference pricing | Sets maximum prices using prices in high-income foreign countries. | More than 5% lower on average in 2031. |
| Negotiating prices for additional Medicare drugs | Expands the number of medicines selected for Medicare price negotiation. | 0.1% to 3% lower on average in 2031, depending on the modeled scenario. |
| Extending negotiated prices to commercial purchasers | Applies negotiated prices beyond Medicare to commercial buyers. | 1% to 3% lower on average in 2031. |
| Commercial-market inflation rebates or policies to improve competition or information | Uses rebates when prices rise faster than inflation, or seeks to strengthen competition or improve information. | A comparable average-price reduction is not stated in the cited CBO estimates. |
The market-wide average can conceal a much larger effect on the medicines directly affected. Under one modeled expansion of Medicare negotiation, CBO estimated that the additional drugs selected would have Part D net prices 25% to 40% lower in 2031. Because those medicines account for only part of total spending, the estimated reduction across average prices was smaller.
Reference pricing also carries a possible response: manufacturers could change prices or availability in foreign markets. CBO’s estimate is therefore a modeled effect, not a frictionless calculation that assumes market participants never adapt.
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Who benefits, and who bears the costs?
The answer varies by policy and by medicine. Patients may benefit if a lower price reaches their out-of-pocket costs, but a reduction in a plan’s net cost is not by itself proof that every enrollee’s pharmacy bill falls. Medicare, Medicaid, commercial insurers, beneficiaries, manufacturers, and taxpayers can experience different effects.
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Competition is another route to lower prices. CBO identifies competition from medicines with similar clinical effects as one factor that can constrain brand-name prices, alongside exclusive sales rights under patent and FDA approval rules, insurance coverage, and the characteristics of each market segment. Exclusivity periods vary, so a medicine’s competitive environment—and the financial opportunity for a potential competitor—can change over time.
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How does the Inflation Reduction Act fit in?
The Inflation Reduction Act (IRA) combines distinct policies, not a single price-control mechanism. It provides for negotiation of selected high-expenditure drugs, inflation rebates when certain prices rise faster than inflation, and a redesign of the Medicare Part D benefit that caps annual enrollee out-of-pocket spending and shifts more financial liability to plans and manufacturers.
These components can affect different outcomes. Negotiation and rebates concern prices or manufacturer payments; Part D redesign concerns the insurance benefit and how costs are divided. A change in federal spending therefore cannot, on its own, establish whether patients are more affordable or whether negotiated prices fell.
In a July 2026 update, CBO said spending reductions from negotiation and inflation rebates had been smaller than it first estimated, while costs from Part D redesign had been substantially larger than anticipated. CBO then projected that the provisions together would increase deficits over 2022–2031. This was a revision to a federal budget projection, not a finding that the policies had no effect on negotiated prices or patients’ out-of-pocket costs.
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Could lower prices slow the development of new medicines?
There is a plausible economic tradeoff: if a policy reduces the revenue manufacturers expect from a medicine or raises the cost of investing in it, some R&D becomes less attractive. CBO described that mechanism in its October 2024 analysis. The size of any effect depends on the policy and on which products and markets are affected.
For the IRA, CBO’s 2022 estimate, as reported by the Congressional Research Service (CRS), projected 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 observed counts of medicines that failed to reach patients. CRS notes that the full effects may take years to emerge as more drugs become eligible.
Those estimates do not establish the clinical value of any projected reduction, identify a specific medicine that will not be developed, or settle how innovation will respond over the long run. The evidence supports neither a claim that innovation is untouched nor a claim that a known number of valuable treatments will be lost. Long-term causal effects remain uncertain.
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What should policymakers weigh alongside the price reduction?
A policy should be judged by more than one headline figure. The key questions are:
- Which price changes? Separate list prices, negotiated prices, and net prices after rebates and discounts.
- Whose costs change? Examine effects on patients, Medicare, Medicaid, commercial insurers, manufacturers, and public budgets rather than assuming they move together.
- Which medicines and market segments are affected? A large reduction for selected drugs can coexist with a modest change in the overall market average.
- How might participants respond? Manufacturers can alter pricing or availability, while insurers and other buyers may adjust their behavior.
- What happens to competition and future R&D? Consider existing alternatives and changing exclusivity, alongside the possibility that lower expected returns affect investment in future medicines.
CBO’s October 2024 analysis compared policy options discussed in legislation, public debate, or use in high-income countries; it explicitly stated that including or omitting an approach did not signal endorsement or rejection. Its estimates help show possible price effects under modeled assumptions, but they do not remove the need to weigh affordability, market responses, and uncertain innovation effects separately.
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