The Inflation Reduction Act's drug price negotiation program faces uncertainty under Trump's administration. The 'pill penalty' provision, which allows small molecule medicines to be eligible for selection nine years after FDA approval, four years before large molecule medicines, has sparked controversy. Critics argue this disparity could harm investment in small molecule drug development. Proposed bills like the EPIC Act aim to provide parity for the two drug classes, but budgetary concerns and arguments against extending small molecules' exclusivity period complicate the issue. The biopharma industry, including organizations like PhRMA and BIO, strongly opposes the 'pill penalty', fearing reduced R&D investment and fewer small molecule medicines developed.