PIPC appreciates the administration’s goals to lower health costs for patients. PIPC remains concerned that the latest proposals to advance a Most Favored Nation pricing model for drugs will, in effect, import the worst of foreign health systems – their reliance on discriminatory value assessments. Stories from outside the U.S., like that of the Williams’ family, illustrate why quality-adjusted life years (QALYs) have no place in U.S. policy. Patients do not have the luxury of time.
PIPC has a long history raising awareness about the implications of government reliance on measures like QALYs and the degree to which decisions about treatment choice and access will be made by government agencies instead of doctors and patients. Since its founding and regardless of the political party advancing policy ideas, PIPC has stood for patients by standing against use of biased and discriminatory measures of “cost effectiveness”, including QALYs and similar measures, in reimbursement and coverage decisions. It is well known that foreign governments rely on methodologies like QALYs that devalue people with chronic and disabling conditions, resulting in policy decisions that view such patients as worth less to treat. Some countries also devalue new innovations by referencing the cost of older less effective treatments as the basis for reimbursement rates, resulting in newer products being inaccessible to patients in those countries.
Therefore, PIPC strongly urges the administration to continue its efforts to lower out-of-pocket costs for patients while also working to ensure all Americans can access the latest innovations without the delays we see in other countries. We urge CMS to avoid policies that rely on discriminatory cost-effectiveness thresholds, to protect patients and people with disabilities who may not fit an average QALY-based assessment and to appropriately value and incentivize new innovations that improve quality of life for people living with disabilities and serious chronic conditions. We welcome additional information on the administration’s intentions to analyze the impact on patients of new Medicare and Medicaid models relying on foreign government pricing, including the impact on efforts to address unmet needs of patients through innovation.
We look forward to working with the administration to safeguard against government policy relying on QALYs and similar measures, whether directly or through reliance on other countries’ decisions, so that health care decision-making is centered on patient needs, not payers.
Therefore, PIPC strongly urges the administration to continue its efforts to lower out-of-pocket costs for patients while also working to ensure all Americans can access the latest innovations without the delays we see in other countries. We urge CMS to avoid policies that rely on discriminatory cost-effectiveness thresholds, to protect patients and people with disabilities who may not fit an average QALY-based assessment and to appropriately value and incentivize new innovations that improve quality of life for people living with disabilities and serious chronic conditions. We welcome additional information on the administration’s intentions to analyze the impact on patients of new Medicare and Medicaid models relying on foreign government pricing, including the impact on efforts to address unmet needs of patients through innovation.
We look forward to working with the administration to safeguard against government policy relying on QALYs and similar measures, whether directly or through reliance on other countries’ decisions, so that health care decision-making is centered on patient needs, not payers.
