27 Mar Congress Can Protect Healthcare Access and Equity by Passing the EPIC Act
Pills and tablets (aka small-molecule medicines) have long been the backbone of accessible, affordable treatment — especially for underserved communities. These medicines treat everything from cancer to heart disease and Alzheimer’s without requiring hospital visits, infusions, or time off work.
But unless Congress acts soon, misguided policy could discourage any future investments in these essential therapies, exacerbating health disparities for communities of color and people with disabilities.
The recently introduced Ensuring Pathways to Innovative Cures (EPIC) Act is a smart, bipartisan solution. The bill would correct a harmful imbalance in the Inflation Reduction Act by giving small-molecule medicines the same exemption period from Medicare price negotiations that biologics — typically injected or infused medications — receive. This simple, targeted change would restore parity and ensure continued investment in treatments vulnerable patients rely on.
Under current law, biologics are exempt from Medicare price setting for 13 years after FDA approval. Small-molecule medicines, by contrast, are only protected for 9 years. That four-year gap significantly reduces the potential to recoup investments. A substantial share of returns comes between years 10 and 13, and losing that window makes it nearly impossible to recover the billions of dollars required to develop a new drug. The result? Critical early-stage researchers and investors are already pulling back from small-molecule research.
Since the IRA passed, small-molecule drug investment has dropped by 70%, and at least 20 experimental drugs have been either paused or shelved.
That’s a major setback for health equity. Small-molecule medicines represent 9 out of every 10 prescription drugs. They’re often the most accessible option for people with limited mobility, transportation, or caregiving support — barriers that disproportionately affect people of color and people with disabilities. Unlike biologics, these medications can be picked up at a local pharmacy and taken at home.
That matters. Transportation barriers impede access to care for 5.8 million Americans each year. Delaying or deterring the development of at-home therapies would only widen existing gaps.
These disparities are further compounded by disproportionate chronic disease burden:
- Black Americans have the worst cancer death rate of any racial or ethnic group in the United States and “are more likely than white people to be diagnosed with female breast, lung, and colorectal cancers at a late stage,” according to the CDC. Black individuals are also “roughly twice as likely as white people to die from diabetes” and “more likely than white people to die from heart disease,” per KFF analysis.
- For Hispanic and Latino Americans, cancer is the leading cause of death. As reported by the CDC, “Hispanic and Latino people have higher rates of getting and dying from some kinds of cancer” — including stomach and cervical cancers — than most other groups. Compared to white adults, Hispanic adults are also “60% more likely…to be diagnosed with diabetes” and “more than twice as likely to be hospitalized for treatment of end-stage renal disease related to diabetes,” according to CDC and AHRQ data.
Small-molecule therapies are at the forefront of precision treatments for cancer, diabetes, hypertension, and more — but future breakthroughs may never reach these communities if the current disincentives persist.
For the one in four U.S. adults with disabilities, the stakes are equally high. In addition to facing accessibility challenges, they are also more likely to have other chronic conditions. Among individuals with Down syndrome, for instance, most develop Alzheimer’s-related brain plaques by age 40, and at least half go on to develop dementia by their 60s. Many small-molecule drugs are uniquely capable of crossing the blood-brain barrier — a critical feature for treating Alzheimer’s and other cognitive conditions. These are precisely the types of experimental therapies in development that could be deprioritized without the protections offered in the EPIC Act.
The Health Equity Collaborative has long advocated for a policy environment that supports both innovation and equitable access. Advancing legislation like the EPIC Act helps ensure that medical breakthroughs are developed with underserved patients in mind and remain within reach.