In preparation for a Senate hearing that will highlight lower foreign drug prices, a coalition that includes drug makers and patients is reminding Democrats that their 2020 party platform opposes using a metric that is key to drug-value assessments: quality-adjusted life years (QALY).
The hearing, scheduled by subcommittee Chair Bernie Sanders (I-VT), worries Partnership to Improve Patient Care Chairman Tony Coelho because some countries use QALYs to set drug prices. Coelho says the metric devalues treatments for people with disabilities and the elderly who have fewer years to live.
PIPC’s steering committee includes lobbying groups for patients and drug makers.
The U.S. government does not have a uniform policy on QALYs. Some federal agencies are banned from using measurement tools like QALYs, but state Medicaid programs use them. The National Council on Disability, an independent government agency, said both public and private insurance should be banned from using QALYs to assess the value of drugs.
Also, as Coelho points out, the Democratic 2020 party platform promises to not use QALYs.
“Democrats will ensure that people with disabilities are never denied coverage based on the use of quality-adjusted life year (QALY) indexes,” the July 2020 platform states.
However, House Democrats are in favor of international referencing for drug prices -- H.R. 3 calls for using the lowest prices among other developed countries as the price floor in Medicare negotiations. The Congressional Budget Office relied heavily on analyses by the Institute for Clinical & Economic Review, which uses metrics such as QALYs, when CBO estimated the budget impact of Medicare price negotiation. CBO’s reliance on ICER is a sign that the organization could become powerful if the government moves to a system that bases prices on the value of drugs to the health care system.
ICER’s prominence is in part due to opposition from the drug industry and patient groups. During the Obamacare debate, Democrats considered funding research that compares products and services. But in response to heavy lobbying by drug makers and patients, Congress banned the quasi-governmental Patient-Centered Outcomes Research Institute from considering cost in its comparative-effectiveness research, so ICER has filled that void.