Several of the 14 countries that the Administration originally proposed in 2018 to be referenced by the United States base their own prices on Quality-Adjusted-Life-Year (QALY) cost-effective assessments. These discriminatory QALY assessments assign a value to health improvements and outcomes, and the United States by importing foreign drug prices, would also be importing the use of QALYs. This means patients with chronic conditions, disabilities, and seniors would often be deemed too expensive to receive certain treatments.
In addition, many of the countries that the Centers for Medicare & Medicaid Services (CMS) have proposed referencing in this IPI model have significantly less access to new drugs and must wait extended periods to receive that care compared to patients in the U.S. Consider cancer patients for a moment. Of the 74 cancer drugs that launched between 2011 and 2018, 95 percent are available in the United States compared to just 74 percent in the U.K. and only 49 percent in Japan. Moreover, even after those drugs are approved they are often delayed in reaching patients by 17 months on average. The National Council on Disability provided additional examples of therapies for Alzheimer’s Disease and cystic fibrosis not being covered due to reliance on cost effectiveness studies in England. Cancer and other chronic conditions require strict care plans to manage the illness effectively and the slightest reduction in access or delays in care could be life-threatening.
If the administration were to move forward with the IPI model, it will be at the expense of health outcomes. Patients and people with disabilities will see restrictions under this new system, limiting access and patient choice of treatment. The use of third-party middlemen will create new hurdles and add administrative burdens to providing care, potentially delaying or disrupting already effective treatment plans.
We must act NOW to tell the Administration just how harmful this proposal would be and urge them to instead focus on patient-centered solutions that recognize individual value of patients and emphasize human dignity.