By Christine Brennan

A woman’s death from a preventable heart attack isn’t just a misunderstanding of cardiovascular biology — it’s a failure of policy.

And when her doctor misdiagnoses her autoimmune flare as stress, or when a hot flash relief drug never reaches pharmacy shelves because it’s deemed financially unviable — these aren’t mere unfortunate accidents. They’re the direct result of systemic underinvestment, outdated assumptions, and misaligned incentives in U.S. healthcare policy.

For too long, women’s health has been an afterthought — not just in treatment, but in the lab, in budgets, and in the laws that shape our drug development system. And instead of correcting these historical imbalances, the Inflation Reduction Act (IRA) threatens to deepen them.

The historic neglect of women’s health has touched nearly every corner of the medical industry. Cancer rates in women under 50 are over 80% higher than in men under 50. Women are more likely to die from heart attacks. Four out of five people living with autoimmune diseases are women. Nearly two-thirds of Alzheimer’s patients are women. Thyroid disease affects women ten times more often than men.

According to a McKinsey analysis, women spend 25% more time than men in poor health — and investments addressing the women’s health gap could bolster the global economy by $1 trillion annually by 2040.

Yet between 2013 and 2023, only 10% of NIH funding went toward women’s health. That’s not an oversight. That’s a signal — a signal of who our system is designed to serve, and who it’s willing to overlook.

The Inflation Reduction Act inadvertently worsens this problem. The law was designed to reduce costs for patients by allowing Medicare to negotiate lower prices on certain high-cost prescription drugs. But in doing so, it created an uneven playing field — one that threatens the development of many medicines women depend on.

The law gives a longer period of protection from government price-setting to large molecule drugs, called biologics, than it does to small molecule drugs. Biologics get 13 years. Small molecules get only nine.

Four years may not seem like much. But in the economics of drug development, it’s the difference between go and no-go. When developers face a shorter runway to recoup their investment, many choose not to develop the drug at all.

And small molecule treatments are essential for women’s health.

Consider azathioprine, a small molecule drug that helps women with lupus control painful and dangerous flare-ups. Or methimazole, which has brought relief and stability to women living with Graves’ disease, a thyroid disorder that can cause everything from tremors to heart complications. Leflunomide has made life manageable for countless women with rheumatoid arthritis, helping them work, care for their families, and move through the world without debilitating pain. And Veozah — a recently approved non-hormonal treatment for hot flashes — has offered long-overdue relief to women enduring a symptom that, while often dismissed as trivial, can wreck sleep, sap confidence, and disrupt daily life.

Had the IRA’s rules been in place when these drugs were in development, some of them might never have reached patients. Major pharmaceutical companies are already pulling back from small molecule drug research, particularly in areas like cancer and mental health.

Genentech is reportedly reconsidering an ovarian cancer drug — not because it isn’t promising, but because it makes more financial sense to pursue a prostate cancer application first. The reason? The law starts the countdown on price controls from the first FDA approval. So it makes financial sense for Genentech to focus on the largest total addressable market. That means first seeking approval as a treatment for prostate cancer — which affects 3.5 million American men — and then only later pursuing approval as a treatment for ovarian cancer, which afflicts about 250,000 American women.

This is what inequity looks like when it’s encoded in policy: a financial incentive to treat men first, and women later — if at all.

This doesn’t have to be the end of the story. President Trump just signed an executive order pledging to undo this so-called “pill penalty” and ensure all treatments receive funding based on their medical potential, not their molecular weight. The EPIC Act, a bipartisan proposal in Congress, would likewise fix this distortion by simply giving small molecule drugs the same 13-year protection that biologics receive. That one change would realign incentives, restore investor confidence, and give women-focused treatments a fighting chance to make it to market.

Women have been underdiagnosed, undertreated, and underserved for decades. There is finally growing awareness of the gap.

But awareness alone isn’t enough. We need action — including more funding for research into how biological sex plays a role in the pathology of diseases, as well as thoughtful policy that encourages medical developments for women’s health. As an investor committed to advancing healthcare innovation, I’d hate to see more promising treatments — especially those affecting women — struggle to secure funding as an inadvertent result of the Inflation Reduction Act.

Christine Brennan, Ph.D. is managing director at Vertex Ventures HC and secretary of the board for Incubate, a Washington-based coalition of life-science venture capitalists.