PIPC Strongly Opposed to Reliance on Foreign QALY Standards in CMS’ Final Rule Imposing “Most Favored Nation” Drug Pricing in Medicare Part B

Today, the Centers for Medicare and Medicaid Innovation (CMMI) finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) model that would impose so-called “Most Favored Nation” drug pricing in Medicare Part B. PIPC is deeply concerned about embedding in U.S. policy the use of cost-effectiveness standards like the quality-adjusted life year (QALY), which devalues the lives of people with disabilities and older patients. Whether it’s adopted into a payment price, benchmark, coverage policy, or reimbursement incentive, reliance on QALY-based policy is the wrong approach for patients and people with disabilities. Adopting the values of other countries that routinely deny patients access to breakthrough treatments for serious and disabling conditions puts American patients at risk of the same outcome. We support the agency’s goal of lowering drug prices for all Americans, but it is critical that it is done in ways that respect existing statutory safeguards against QALYs and work for all Americans. 

We look forward to working with Congress and the administration on steps to ensure Medicare protects people with disabilities and complies with the current laws that bar the use of QALYs and similar measures in Medicare decisions. ​

In this week's edition...

-- MFN Policies Limit Patients’ Ability to Access Treatments that Work Best for Them. As lawmakers continue to explore most favored nation pricing, they must listen to patients like Crystal.
-- USPSTF Changes Imply a Shift Toward Consideration of Cost Effectiveness. View the Inside Health Policy article here ($). View the AcademyHealth statement here. 
-- Ruling Vacating Community Integration Provisions in 2024 Section 504 Rule. View the AAPD statement here. Learn more about the DCIC here.
-- Maryland Matters: The Danger of PDABs for Patients. Read a recent opinion piece, Gone from the shelf: The hidden danger of drug price caps, here.
-- Legacy HTA: Deconstructing the Impossible QALY. View the Class Notes here.
-- 86 Organizations Comment to Senate Finance Committee, Oppose Importing QALYs, Urge Decisions Centered on Patients and People with Disabilities. View the RFI comments here.
-- New Research Highlights Gaps in Use of CER and Patient Experience. View PIPC's Data Mine Blog analysis here and a recent Value in Health article here.
-- PCORI Seeking Input on Research Priorities. Click here to submit your ideas by Nov. 2.
-- PIPC Submits IPAY 2028 Comments to CMS. View the IPAY 2028 comments to CMS here.
-- Washington Examiner: Review of Implications of Germany, Foreign Drug Prices. Read the Washington Examiner article here.
-- As the ADA Turns 36, PIPC Highlights Work to be Done. Learn More About How the QALY Devalues Disabled Lives. View examples of QALY health utilities that assign a lower value to the lives of people with disabilities here.
-- Join IVI for 2026 Whole Health Policy Summit in November. Learn more here. Register to attend in person here. Register to attend the livestream here. 
-- ICHOM Seeking Experts in Cataracts, Plus Annual Conference December 7-9. Register here!
-- ICHOM Advances the Spinal Muscular Atrophy Patient Validation Survey. Complete the Patient Validation Survey here.
— PCORI Annual Meeting October 19-20. Click here to register.
— Senator Collins Speaks Up Against Importing QALYs to the U.S., Committee Advances Charlotte’s Bill. The video is available on LinkedIn here and on X here. We encourage others to share PIPC’s social media thanking the Senator on LinkedIn here and on X here. Hear Charlotte herself describe this terrific progress here.
— AMA Opposes Policies Setting Prices by Exclusive Reference to Other Countries or Averages. View the resolution here.
— Tell Congress to Oppose Most Favored Nation Policies Importing QALYs to the U.S. Learn more here. Reach out to your Member of Congress here. 
— Emerging Threats in States for Use of Discriminatory Metrics. See details below.
— What Happens in Countries Using QALYs and Cost-Based Thresholds? See details below.— ICER's QALY-Based Study Topics. See details below.
— Upcoming Events and Webinars. See details below.

In this week's edition...
 
— 86 Organizations Comment to Senate Finance Committee, Oppose Importing QALYs, Urge Decisions Centered on Patients and People with Disabilities. View the RFI comments here.
— New Research Highlights Gaps in Use of CER and Patient Experience. View PIPC's Data Mine Blog analysis here and a recent Value in Health article here.
— PCORI Seeking Input on Research Priorities. Click here to submit your ideas by Nov. 2.
— PIPC Submits IPAY 2028 Comments to CMS. View the IPAY 2028 comments to CMS here.
— Washington Examiner: Review of Implications of Germany, Foreign Drug Prices. Read the Washington Examiner article here.
— As the ADA Turns 36, PIPC Highlights Work to be Done. Learn More About How the QALY Devalues Disabled Lives. View examples of QALY health utilities that assign a lower value to the lives of people with disabilities here.
— MFN Policies Limit Patients’ Ability to Access Treatments that Work Best for Them. We must not import access restrictions that devalue people living with rare diseases.
— 100 Members of Congress call on DOJ To Rescind Olmstead Memo. View the letter here. View a message from Senator Kirsten Gillibrand here.
— Join IVI for 2026 Whole Health Policy Summit in November. Learn more here. Register to attend in person here. Register to attend the livestream here. 
— ICHOM Seeking Experts in Cataracts, Plus Annual Conference December 7-9. Register here!
— ICHOM Advances the Spinal Muscular Atrophy Patient Validation Survey. Complete the Patient Validation Survey here.
— PCORI Annual Meeting October 19-20. Click here to register.
— Senator Collins Speaks Up Against Importing QALYs to the U.S., Committee Advances Charlotte’s Bill. The video is available on LinkedIn here and on X here. We encourage others to share PIPC’s social media thanking the Senator on LinkedIn here and on X here. Hear Charlotte herself describe this terrific progress here.
— AMA Opposes Policies Setting Prices by Exclusive Reference to Other Countries or Averages. View the resolution here.
— Tell Congress to Oppose Most Favored Nation Policies Importing QALYs to the U.S. Learn more here. Reach out to your Member of Congress here. 
— PIPC Report: The UK Health System, Lessons for the U.S. and the Risks of MFN Drug Pricing. Click here to read the full report.
— Emerging Threats in States for Use of Discriminatory Metrics. See details below.
— What Happens in Countries Using QALYs and Cost-Based Thresholds? See details below.
— ICER's QALY-Based Study Topics. See details below.
— Upcoming Events and Webinars. See details below.

In this week's edition...
 
— 86 Organizations Comment to Senate Finance Committee, Oppose Importing QALYs, Urge Decisions Centered on Patients and People with Disabilities. View the RFI comments here.
— PIPC Conducts New Research on Use of Evidence Centered on Patient Experience in Medicare Drug Price Negotiation, Submits IPAY 2028 Comments to CMS. View PIPC's Data Mine Blog analysis here and the IPAY 2028 comments to CMS here.
— As the ADA Turns 36, PIPC Highlights Work to be Done. Learn More About How the QALY Devalues Disabled Lives. View examples of QALY health utilities that assign a lower value to the lives of people with disabilities here.
— MFN Policies Limit Patients’ Ability to Access Treatments that Work Best for Them. We must not import access restrictions that devalue people living with rare diseases.
— 100 Members of Congress call on DOJ To Rescind Olmstead Memo. View the letter here. View a message from Senator Kirsten Gillibrand here.
— ICHOM Seeking Experts in Cataracts, Plus Annual Conference December 7-9. Register here!
— PCORI Annual Meeting October 19-20. Click here to register.
— Senator Collins Speaks Up Against Importing QALYs to the U.S., Committee Advances Charlotte’s Bill. The video is available on LinkedIn here and on X here. We encourage others to share PIPC’s social media thanking the Senator on LinkedIn here and on X here. Hear Charlotte herself describe this terrific progress here.
— AMA Opposes Policies Setting Prices by Exclusive Reference to Other Countries or Averages. View the resolution here.
— Tell Congress to Oppose Most Favored Nation Policies Importing QALYs to the U.S. Learn more here. Reach out to your Member of Congress here. 
— PIPC Report: The UK Health System, Lessons for the U.S. and the Risks of MFN Drug Pricing. Click here to read the full report.
— Emerging Threats in States for Use of Discriminatory Metrics. See details below.
— What Happens in Countries Using QALYs and Cost-Based Thresholds? See details below.
— ICER's QALY-Based Study Topics. See details below.
— Upcoming Events and Webinars. See details below.