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  • ​“It’s devastating to not even be able to try a drug that could work for you… I understand a line has to be drawn but it feels unfair that other people make decisions about your life and how much it's worth.”

    - Patient with breast cancer in the U.K.

  • ​“It’s incredibly cruel to use the cost-effectiveness line and it makes me shake with rage…It’s like being in a dystopian society – it has been approved in Scotland and the US and Europe but England is just lagging so far behind… It’s an abomination of human rights that the drug isn’t available. It feels like discrimination against his disability.”

    - Parent of child with SMA in the U.K.

  • "There's no way I can't try this drug. It's the last thing that might save my life… It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication."

    - Patient with breast cancer in Canada

  • ​"'If they do approve it in September, she could be too far gone and then we’d be told it’s not worth the NHS’s resources."

    - Parent of child with Batten’s disease in the U.K.

What Happens in Countries Using QALYs and Cost-Based Thresholds to Determine Coverage

Other countries are often referenced as examples of how the use of QALYs or similar cost-based thresholds impact access to care:​
  • New Zealand: Breast cancer patients are not receiving access to to life-saving medications. As a result of widespread criticism, PHARMAC is set to review its practices of breast cancer drug funding. Click here to read more. PHARMAC has claimed to cover a breast cancer treatment that it does not cover. Patients in New Zealand also face barriers to access for treatment of spinal muscular atrophy. Click here to read more. New Zealand advocates unfavorably compare its cancer drug coverage to other countries.
  • Canada: Discriminatory cost effectiveness measures are blocking access to care for patients with spinal muscular atrophy patients. Click here and here to read more. Click here to view the story of a child with thyroid cancer forced to come to the U.S. for care, and here for an article about high costs of Parkinson's and MS treatments. Click here for a story about a patient with cystic fibrosis whose province does not cover the drug she needs.
  • Netherlands: Cost effectiveness measures are blocking access to cystic fibrosis treatments for children. It also remains unavailable for adults because the government has failed to reach an agreement. Click here to read more.
  • United Kingdom: English families are moving to Scotland and Ireland in an attempt to access MS drugs not covered by the NHS. Activists are fighting for access to treatments for cystic fibrosis and cancer. Click here and here for articles related to cystic fibrosis. Click here and here to read about the fight for access to cancer drugs in Scotland. Click here for an article related to MS. Click here for more information on the NHS drug approval process. Click here for an article about the fight for access to spinal muscular atrophy drugs.
  • France: Patients are alarmed as a multiple sclerosis drug will no longer be covered.
Learn More

Case Studies

CVS: Value Our Health

In August, CVS announced that they would offer new insurance plans that exclude drugs if they exceed a subjective “cost-effectiveness” threshold. 

White Paper: Uses and
​Misuses of the QALY

Value assessment, and the use of cost-effectiveness in particular, is receiving renewed interest as a tool for controlling health care spending.

PIPC Respose to CEVR Article on ICER's New 'evLYG'

In response to a recent blog post entitled “Will ICER’s Response to Attacks on the QALY Quiet the Critics?” PIPC Chairman Tony Coelho replies: Absolutely not.

Letter on Proposed International Pricing Index 

PIPC's letter highlights concerns that this new policy would import QALY-based standards to key U.S. health programs

Chairman Coelho in San Jose Mercury News

PIPC Chairman Tony Coehlo penned an op-ed in The Mercury News outlining his concerns with the Trump administration’s proposed international drug pricing index. ​