The Inflation Reduction Act’s already been implemented and Republicans won’t repeal it.

But, even if Republicans gain majorities in the House and Senate in today’s midterms, the Inflation Reduction Act won’t be repealed any time soon. In fact, it’s unlikely the Act will ever be fully reversed. Most of the drug pricing provisions, in particular, will likely remain on the books permanently.

While a GOP-led House and Senate could formally repeal the Inflation Reduction Act, for the next 26 months they would face a President who wields veto power. Therefore, no matter what happens in the midterms, 2025 would be the earliest Republicans could take action to successfully rescind the law.

By then, however, many of the Act’s provisions will have been implemented, at least to a large degree. At that point, according to Senator Cassidy (R-LA), “there’s actually little that can be done to claw back the funding. ... The money has largely left Congress’ purview.” This means that, supposing a Republican wins the presidency in the 2024 election, there would still be a steep uphill battle to overturn the legislation.

Moreover, it’s not at all certain all Republicans would be on board with repealing the entire law, especially the drug pricing components, which have consistently been very popular among constituents, whether Democrats, Independents, or Republicans.

Several years from now there could very well be an influential repeal and replace faction within the Republican Party who would want to jettison parts of the bill, but keep others, such as the $2,000 annual cap on out-of-pocket spending by Medicare Part D (outpatient) beneficiaries, a restructuring of the pharmacy benefit, and the imposition of mandatory rebates if list prices of outpatient drugs exceed inflation.

In fact, while some Republicans have discussed a wholesale repeal of the law, including drug pricing provisions, others have remained noticeably silent. This makes sense, as many of the law’s measures were contained in previously drafted bipartisan proposals in Congress. For instance, the Senate bill, S.2543, sponsored by Senators Grassley (R-IA) and Wyden (D-OR), passed the Senate Finance Committee in the summer of 2019. It contains several pillars of the Inflation Reduction Act’s drug pricing provisions; namely, temporary add-on payments for biosimilars in Part B (physician-administered drugs), inflationary rebates for list prices of Part D (outpatient) drugs that increase in excess of inflation, and a comprehensive restructuring of the Part D benefit. The latter establishes an out-of-pocket spending cap for Medicare beneficiaries and a reallocation of liability for costs in the coverage and catastrophic phases, mainly from government (Medicare) to payers (pharmacy benefit managers) and drug companies.