The Inflation Reduction Act (IRA) introduced a critical distinction between small and large molecule drugs that threatens innovation and access to life-saving treatments, especially for older adults, cancer patients, rural communities, and those with chronic or rare diseases. This GCOA policy brief explores how the IRA’s “pill penalty” disincentivizes the development of small molecule therapies, which are often more affordable, accessible, and are essential to healthy aging. Further, the report outlines the IRA’s disproportionate impact on these vulnerable populations and the broader implications for U.S. innovation, and how congressional action through the EPIC Act may help to correct this policy imbalance.