As someone living with epilepsy, I care about making sure drugs are affordable. As both a patient and the lead author of the Americans with Disabilities Act, I care just as much about finding solutions that engage and empower patients and people with disabilities.
In August 2018, CVS Caremark announced a program that does just the opposite, instead offering up a troubling proposal that tells patients what they’re worth instead of asking them what they value.
As I wrote in a recent blog, under the new policy, CVS would offer insurance plans that exclude drugs if they exceed a subjective “cost-effectiveness” threshold. CVS would rely on a deeply flawed value assessment model that would deny access to medications that don’t meet their “cost per quality-adjusted-life-year” (QALY) limit.
This type of cost effectiveness analysis discriminates against people with disabilities and other vulnerable groups like the elderly because it assigns higher value to people in “perfect health” than people in less-than-perfect health. So let’s say your child has a degenerative neurological condition and an expensive new drug is introduced that can halt, but not reverse, the damage done by the disease. Your child, and other patients like her, would be considered “worth less” under a cost-effectiveness formula. As a result, the new treatment would not meet the threshold.
It is not right for patients and people with disabilities to be caught in the middle of this fight to lower health care costs. Reliance on cost-effectiveness thresholds is intended to standardize and limit care options, replacing deeply personal, individual health care decisions with an algorithm that does not address the needs of different patients.
Sign now to demand that insurers stop relying on discriminatory cost-effectiveness thresholds.