In 1971, the National Cancer Act declared a war on cancer, making it a national priority to attack this scourge of diseases.
Fifty-five years later, we can say we are winning. Mortality rates have dropped for a vast majority of cancer types. The American Cancer Society just announced a new milestone: seven in 10 patients now survive five years or more after diagnosis. The report credits better treatment options, along with earlier detection methods and reductions in smoking.
This is personal to me. I lost my dad in 2024 to esophageal cancer. My mother continues her own cancer journey. In 2026, 2.1 million people in the U.S. will unfortunately hear the words “You have cancer.” Those are words you don’t forget.
And yet, today,there is more hope than ever. The treatments we now have would have been science fiction when I was in pharmacy school. The sustained, high-risk investments from scientists at drug companies have yielded remarkable innovations. Decades of research and risk-taking in biopharmaceuticals are what made that hope possible.
Even so, too many patients still don’t have a treatment that works for them.
Sadly, the greatest threat to continuing this progress may not be the limits of science. It’s bad policy choices.
When President Biden signed the Inflation Reduction Act (IRA) in 2022, his administration sold the IRA’s “Medicare Drug Price Negotiation Program” (DPNP) as delivering much-needed cost savings to patients. Instead, the law cost more than the Congressional Budget Office projected, required a bailout to insurers, is affecting Medicare Part D plan choices for seniors, and is threatening future innovation–particularly for small molecule drugs.
Cancer drugs account for five of the first 25 drugs selected for the DPNP. That number has risen to nine as Centers for Medicare and Medicaid Services Administrator Mehmet Oz and his team announced the next round of drugs in late January. Over time, we can expect the number of cancer treatments selected to grow, particularly as drugs covered by Medicare Part B are now being selected. These physician-administered drugs include many drugs that treat cancer.
We owe it to every patient waiting for a breakthrough to ensure that our policies accelerate, rather than arrest, the pace of discovery.
We hope CMS will consider the evidence of what might happen to our tools to beat cancer if a race to the bottom continues.
We’re seeing a reduction in industry-funded, post-approval clinical trials for cancer treatments. These trials are essential for testing the efficacy of existing treatments in new patient populations and discovering whether an approved drug is effective for another type of cancer or an earlier line of therapy. Research has demonstrated that follow-on cancer drug approvals actually target earlier stages than initial approvals. The DPNP disincentivizes that new research, and we’re seeing early signals that it is having an impact.
We are also hearing from investors that the IRA is already influencing investment strategy and decisions. One peer-reviewed study showed that 87% of investors interviewed reported the IRA was making it more challenging to bring innovative medicines to market. Nearly four in five said the IRA influenced how they invested in small molecules.
Other research showed that aggregate investments in small molecule companies valued at under $2 billion have dropped by more than two-thirds since the IRA was enacted. For diseases with high exposure to the Medicare population, such as prostate cancer and multiple myeloma, investment has cratered by an even larger percentage.
We are at risk of undoing decades of progress, but it is not too late to change course.
The Trump administration has said that it wants to protect innovation. In one hopeful signal, they took action, through the One Big Beautiful Bill Act last July, to prevent orphan drug research from being punished. Early signals had emerged showing how the IRA was suppressing orphan drug development.
Even without congressional action, CMS has significant latitude to stop a race to the bottom and protect the leadership of the U.S. when it comes to cancer research and development.
The agency can recognize the value of these medicines and the oncology ecosystem when making initial offers, rather than seeking the statutory floor at the start of negotiations. This is particularly important in oncology, where the need to preserve access to multiple treatment options is so vital to the individualized needs of cancer patients.
The agency can continue to respect the innovation and patient-friendliness of combination therapies. They can mean the difference between an hours-long infusion and a much shorter subcutaneous injection—an example of the ways patient-reported outcomes for a particular cancer treatment play an outsized role in their overall treatment experience.
CMS has the authority to define “therapeutic alternatives” in a way that respects the unique biological mechanisms of cancer therapies, rather than treating life-saving innovations as interchangeable commodities.
The Trump administration has put affordability at the center of its domestic policy agenda; it’s how President Trump won the 2024 election, and it’s an effort we strongly support. But targeting the innovators developing cures won’t help the administration make good on its promise to lower costs.
Cancer doesn’t care about political wins or quarterly budget projections. We owe it to every patient waiting for a breakthrough to ensure that our policies accelerate, rather than arrest, the pace of discovery. We can make life more affordable without sacrificing hope. More cancer patients are hoping for the treatment or cure that will give them more time with their loved ones. We hope the administration will continue to incentivize the investments that are helping us win the war on cancer. Patients are counting on it.
John O’Brien, PharmD, MPH, is president and CEO of the National Pharmaceutical Council. He served as senior advisor for drug pricing during the first Trump administration. NPC is a 72-year-old health policy research organization in Washington, DC. NPC serves patients and society with policy-relevant research on the value of patient access to innovative medicines and the importance of scientific advancement. We envision a world where advances in medicine are accessible to patients, valued by society, and sustainably reimbursed by payers to ensure continued innovation.
