The Small Molecule Penalty is a Threat to Health Equity
By Kevin B. Kimble
A seemingly minor provision in last year's Inflation Reduction Act could make it harder for marginalized patients to access the medicines their doctors have prescribed. It could also prevent the future development of cutting-edge, convenient treatments for many diseases that disproportionately impact communities of color.
The Inflation Reduction Act allows the government to lower prices for certain medications. But it doesn't treat all drugs equally. For "small-molecule" drugs that usually come in pill form, price caps kick in after 9 years. But a larger molecule class of medicines called "biologics," which often have to be administered as shots in doctor's offices, are exempt from price caps for four additional years.
Did policymakers act without fully understanding the consequences for all communities?
There is no good medical or scientific reason for this disparity between two important drug categories. Both oral pills and injections serve important functions, and both come with advantages and disadvantages. Oral pills, for instance, can be critical treatment options for those without access to transportation, including many Black patients.
Our policies should strive to increase treatment options and convenience for all patients. Instead, this "small-molecule penalty" will cause drug inventors to shift their money away from medicines that come in pill form.
That's worrying, especially given the ongoing inequities embedded in our healthcare system and the challenges communities of color often face when trying to access care.
Encouraging drug companies to pursue a class of drugs that often have to be taken as injections over medicines that usually come in pill form will only make these inequities worse, particularly for Black Americans. Black Americans are disproportionately likely to live with certain diseases for which easy-to-take pills are considered the holy grail of care.
But cutting-edge pills to treat or cure Alzheimer's disease, type 2 diabetes, and other debilitating illnesses are on the losing end of the IRA's ill-considered policies. I fear that as investors who fund research into new medicines direct their dollars elsewhere, people of color will end up suffering the most in the long-term.
Medications that have to be taken as shots or IV-style infusions are certainly crucial options for many patients, but they still come with downsides. The most important downside from the perspective of health equity is that they can be harder for patients to access and take.
It has long been recognized that communities of color are far more likely to face transportation inequities than White communities are. It is only natural that reducing how many medicines can be taken as pills in the comfort of one's home will magnify the effects of transportation-related structural racism.
The solution here is simple. Congress needs to stop discriminating against one category of drugs over another. The last thing we should be doing is making it less convenient for members of underserved communities to access the care they need.
Kevin B. Kimble, Esq., is the founder and executive director of the Southern Christian Leadership Global Policy Initiative.
