The Inflation Reduction Act (IRA) took important steps to lower costs for some patients by capping annual out-of-pocket costs and allowing beneficiaries to spread their costs over the course of the year in Medicare Part D. Unfortunately, the IRA’s price setting policies do more harm than good for many patients. In particular, the negative impacts are most likely to be felt by underserved communities, who disproportionately bear the burden of many illnesses. This is a system-level miss by Congress that further cements health inequities in the United States.