A study quantified how the Inflation Reduction Act’s “pill penalty” is associated with reduced late-stage small-molecule oncology research. Vital Transformation found a 37% decline in follow-on small-molecule oncology studies and a 27% drop in lead-indication approvals after the IRA’s introduction, with an additional 14% decline in orphan oncology study share. The analysis focuses on secondary clinical trials tied to FDA-approved medicines from 2018 to 2025 and suggests policymakers may need to consider how pricing incentives can discourage indication-expansion work that often delivers additional clinical options.