Partnership to Improve Patient Care

  • Home
  • About
    • Mission and Priorities
    • Meet the Chairman
    • Steering Committee
    • PIPC Member List
    • Contact
  • The Issues
    • Action Center
    • Value Our Health
    • International
    • Where We Stand
    • Value Assessment Frameworks
    • Engaging Patients in Value-Based Payment
    • Patient-Centeredness in Research
  • Resources
    • Advocacy
    • Letters and Comments
    • PCORI Meeting Transcripts
    • Polling
    • Roundtables
    • White Papers
  • News
    • Press Releases
    • PIPC in the News
    • PIPC Weekly Update
    • PIPC Patients' Blog
    • Chairman's Corner
    • The Data Mine
  • Events
    • Nevada AB 259
    • QALY Panel
    • QALY Briefing
    • Past Webinars >
      • MFN/IPI Webinar 2025
      • Discrimination & Health Care
      • C & GT Webinar
      • ICER COVID Webinar
      • Value Our Health Briefing
      • ICER SCD Webinar
      • VOH Sickle Cell Webinar
      • Rare Disease Webinar
      • QALY Webinar
      • PCORI Advocacy Webinar
      • APM Webinar
      • Patient Empowerment Webinar
      • Value Assessments Briefing
    • Past PIPC Forums >
      • 2023
      • 2022
      • 2021
      • 2020
      • 2019
      • 2018
      • 2017
      • 2016
      • 2015
      • 2014
      • 2013
      • 2012
      • 2011
      • 2010
  • Home
  • About
    • Mission and Priorities
    • Meet the Chairman
    • Steering Committee
    • PIPC Member List
    • Contact
  • The Issues
    • Action Center
    • Value Our Health
    • International
    • Where We Stand
    • Value Assessment Frameworks
    • Engaging Patients in Value-Based Payment
    • Patient-Centeredness in Research
  • Resources
    • Advocacy
    • Letters and Comments
    • PCORI Meeting Transcripts
    • Polling
    • Roundtables
    • White Papers
  • News
    • Press Releases
    • PIPC in the News
    • PIPC Weekly Update
    • PIPC Patients' Blog
    • Chairman's Corner
    • The Data Mine
  • Events
    • Nevada AB 259
    • QALY Panel
    • QALY Briefing
    • Past Webinars >
      • MFN/IPI Webinar 2025
      • Discrimination & Health Care
      • C & GT Webinar
      • ICER COVID Webinar
      • Value Our Health Briefing
      • ICER SCD Webinar
      • VOH Sickle Cell Webinar
      • Rare Disease Webinar
      • QALY Webinar
      • PCORI Advocacy Webinar
      • APM Webinar
      • Patient Empowerment Webinar
      • Value Assessments Briefing
    • Past PIPC Forums >
      • 2023
      • 2022
      • 2021
      • 2020
      • 2019
      • 2018
      • 2017
      • 2016
      • 2015
      • 2014
      • 2013
      • 2012
      • 2011
      • 2010

The PIPC Blog

PIPC Weekly Update: September 18, 2023

9/18/2023

 
In this week's edition...
 
— PCORI Seeks Nominations for Advisory Panels. Click here to learn more, to apply to serve on an advisory panel, or submit a nomination.
— CMS Process Should Provide Robust and Ongoing Engagement of Patients and People with Disabilities in Negotiation Process. See details below.
— Letter from Over 1400 Researchers, Organizations and Individuals Opposing NIMHD Exclusion of People with Disabilities. See details below.
— Statement from PIPC Chairman Tony Coelho on the Proposed Section 504 Rule. See details below.
— PIPC Statement on Selection of Drugs Under Medicare Drug Price Negotiation Program Guidance. Click here to read the statement.
— National Forum for Heart Disease and Stroke Prevention Annual Meeting October 26. Click here to register to attend in person or virtually.
— 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.
— AHRQ Effective Program Updates. See details below.
— Job Openings. See details below.
What We're Reading
 
1. PCORI Seeks Nominations for Advisory Panels. PCORI is currently seeking nominations for appointments to its advisory panels. These multi-stakeholder advisory panels must include patients, caregivers, or patient advocates. PCORI advisory panels do not serve in an official decision-making capacity, but their recommendations and advice will be taken into consideration by PCORI. PIPC encourages patients, caregivers, and patient advocates to apply or to submit nominations to serve on PCORI's five advisory panels on: Clinical Effectiveness and Decision Science, Clinical Trials, Healthcare Delivery & Disparities Research, Patient Engagement, and Rare Disease. The application is open through March 29, 2024. Click here to learn more, to apply to serve on an advisory panel, or submit a nomination.
 
2. CMS Process Should Provide Robust and Ongoing Engagement of Patients and People with Disabilities in Negotiation Process. The June 30, 2023 guidance from the Centers for Medicare and Medicaid Services (CMS) stated that CMS will be holding “patient-focused listening sessions in Fall 2023 after the October 2, 2023 deadline for patients and other interested parties to share patient-focused input on therapeutic alternatives and other section 1194(e)(2) data regarding selected drugs.” In its guidance, CMS referenced these listening sessions as a resource for understanding unmet medical need, acquiring new information from patients, identifying relevant outcomes from patients and caregivers and related to therapeutic alternatives. Recently, more information was provided by CMS regarding the patient-focused listening sessions for the selected drug list. Recently, CMS provided further clarification about the listening sessions, stating, "CMS expects a high level of interest in the Listening Sessions. CMS will use a process to randomly select speakers from among the individuals who register for the chance to speak. Approximately 20 speakers will be selected for each Listening Session. A confirmation email will be sent to selected speakers the week of October 9, 2023.” Registration will close October 2, 2023. Click here to view more information about the listening sessions. Click here to view the recommendations from PIPC developed in consultation with other organizations representing patients and people with disabilities. 
 
3. Letter from Over 1400 Researchers, Organizations and Individuals Opposing NIMHD Exclusion of People with Disabilities. On September 8, 2023, letters signed by over 1400 researchers, organizations and individuals expressed opposition to the NIMHD Advisory Committee decision to reject a recommendation to add people with disabilities as a health disparity population. The NIMHD Advisory Committee did not include people with disabilities. Additionally, several people have weighed in about exponential health equity barriers that disabled people from intersecting marginalized groups face - including people of color, people from the LBGTQ+ community, people who live in rural areas, and people who have low incomes. The 2 letters urged the administration to advance a swift course correction on this issue and move to designate people with disabilities as a health disparity population. Click here to view the letter from 1290 people from the disability research community sharing an in-depth analysis about the flaws in this decision-making process. Click here to view the letter from 175 organizations and individuals sharing this analysis and similarly expressing concerns and calling for the recommendation to be reversed.
 
4. Statement from PIPC Chairman Tony Coelho on the Proposed Section 504 Rule.
PIPC Chairman Tony Coelho issued a statement on the Department of Health and Human Services' proposed rule on Section 504 of the Rehabilitation Act.
 
“Since sponsoring the Americans with Disabilities Act in Congress, it has been clear to me that we have to remain vigilant in advocating for enforcement of disability rights laws. I appreciate that the proposed Section 504 rule announced today addresses some of the most important issues that too often were not given oversight from policymakers or the attention of enforcement agencies, yet can result in persons with disabilities being excluded from the benefits of health care programs and activities."
 
​"It will be important for the disability community to comment on all aspects of the proposed rule, ranging from new requirements prohibiting discrimination in the areas of medical treatment; the use of value assessments; web, mobile, and kiosk accessibility; and requirements for accessible medical equipment. As Chair of the Partnership to Improve Patient Care (PIPC) I was excited to see HHS recognize how value assessments devaluing people with disabilities may be used in violation of Section 504 to restrict access to care and we look forward to providing more in-depth comments on these provisions.”
 
5. PIPC Statement on Selection of Drugs Under Medicare Drug Price Negotiation Program Guidance. PIPC released a statement on the list of drugs that will be subject to Medicare price negotiation under the Inflation Reduction Act. "Many patients rely on these treatments for their health and quality of life, and they are the true experts on many of the questions CMS will be answering as part of negotiations. Therefore, we urge CMS to take this opportunity to develop a negotiation process that meaningfully engages patients and people with disabilities. Without input from affected patients and people with disabilities, CMS’ prices may not reflect the diversity of people on treatment or their preferred outcomes." Click here to read the statement.
 
6. National Forum for Heart Disease and Stroke Prevention Annual Meeting October 26. The 2023 annual meeting of the National Forum for Heart Disease and Stroke Prevention will focus on how to broaden support for policies, programs, and environmental changes that improve health and health equity: Health Equity Benefits Everyone: Changing the Narrative on Health Equity. Diverse Panels will discuss how we change the narrative on health equity, including a focus on: Vital Conditions for Well-Being, Reframing Prevention and Public Health, and Reducing the Mental Health Crisis and the Leading Cause of Death Together. Click here to register to attend in person or virtually.
 
Emerging Threats in States for Use of Discriminatory Metrics
 
Several states are considering policies that would reference entities such as the Institute for Clinical and Economic Review (ICER), which calls the discriminatory quality-adjusted life year (QALY) the “gold standard” for value assessment, and others are considering policies to import QALY-based coverage and reimbursement decisions from other countries that restrict access to care. We encourage you to keep track of all state-based threats using this new website tracking state activities. Key issues are highlighted below.
 
  • Click here to learn more about the potential for Prescription Drug Affordability Boards to discriminate by incorporating the use of QALYS.
  • Click here to view the Value Our Health state template legislation that would protect people with disabilities and chronic conditions from the use of QALYs and similar metrics developed by third parties such as ICER in decisions related to reimbursement and coverage, as well as ensure their engagement in decision-making. 
  • Click here to view a one pager about the flaws in ICER’s methodology. 
  • Click here to view information from experts on the downside of referencing foreign countries. 
  • Click here to learn about statutory protections against use of QALYs. 
 
Michigan
A group of Michigan State Senators on Tuesday introduced a suite of bills that would create a Prescription Drug Affordability Board (PDAB). S. 483, S.484, and S.485 would establish a PDAB to institute upper payment limits for the most expensive prescription drugs. The Board, which is appointed and does not maintain spots specifically for patient representatives, would have the authority to review and comment on all prescription drug costs impacting residents of Michigan. The bill includes some language related to the QALY and cost-effectiveness metrics, but it is not a broad QALY ban. The language does not address how the QALY may be used to discriminate by setting QALY-based cost thresholds. Any finalized upper payment limits established by the PDAB would apply to all purchases of the drug intended for sale in Michigan. If enacted, Michigan would become the seventh state to establish a PDAB. 
 
Colorado
Colorado passed legislation in 2021 creating a Prescription Drug Affordability Review Board. The legislation included language stating that the Upper Payment Limit for selected drugs "shall not consider research or methods that employ a dollars-per-quality adjusted life year, or similar measure, that discounts the value of a life because of an individual's disability or age.” However, this limitation did not clearly extend to the process for determining the selected drugs. Presentations related to cost effectiveness analyses to the Colorado Board have referenced the use of a cost-per-QALY or the equal value of life-year gained (evLYG) in estimating cost effectiveness of treatments. This indicates that these metrics may have influenced how Colorado selected the drugs for review.
  • The PDAB offers several opportunities for patients to engage and ensure their voice is heard on these topics:
  • Patient and caregiver surveys will be available between September 12 - October 3
  • Patient and Caregiver meetings on each selected drug will be held through September:
  • Enbrel: Tuesday, September 19 from 6 - 8 pm
  • Genvoya: Wednesday, September 20 from 6 - 8 pm
  • Cosentyx: Thursday, September 21 from 6 - 8 pm
  • Stelara: Tuesday, September 26 from 6 - 8 pm
  • Trikafta: Wednesday, September 27 from 6 - 8 pm
 
Pennsylvania
In the last legislative session, the legislature introduced, HB 1722, a bill creating a Prescription Drug Affordability Board that would not bar reference to QALYs and would explicitly authorize the Board to contract with a third party that could include ICER. The bill has not been reintroduced in 2023. The Pennsylvania legislature held an informational meeting on Prescription Drug Boards in the House Health Committee on April 12 at 10am. Click here to learn more about Prescription Drug Affordability Boards and the implications of discriminatory measures of cost effectiveness. Click here to learn more about the committee chair, Rep. Dan Frankel. 
 
Massachusetts
An Act Advancing Health Care Research and Decision-Making Centered on Patients and People with disabilities, SD. 2117 and HD. 3356 has been introduced in both the House and Senate. This bill includes important patient protections including a ban on the discriminatory Quality-Adjusted Life Year (QALY).
 
Oregon
The Oregon legislature held a hearing on March 27, 2023 on SB 492, legislation that would address the use of biased measures of quality of life, such as quality-adjusted life years or QALYs. PIPC Chairman Tony Coelho submitted testimony stating, "This legislation reflects decades of work to advance disability rights and to end the use of discriminatory measures of the effectiveness of health care that too often drive barriers to care for people with disabilities. In the past this may have been considered just a disability issue, but today we recognize the implications of these biased algorithms for health equity more broadly.” Click here to view testimony from PIPC Chairman Tony Coelho. Click here to view testimony submitted by the Caring Ambassadors Program. Click here to view the list of organizations in Oregon supporting the bill. 
 
On October 6, 2022, the Oregon Health Evidence Review Commission (HERC) discussed a proposed plan for using QALYs. The meeting followed CMS approval of Oregon’s waiver application, which does not bar the use of QALYs in the interim. Click here to read comments submitted by PIPC along with 62 other groups asking CMS to reject the waiver. Click here to view the CMS-approved waiver. At the HERC meeting, the Oregon Health Authority expressed its intent to continue using a prioritized list, shifting it from use under a waiver to use as part of the State Plan Amendment after the waiver expires in 2027. The HERC decided to accept comments on their use of QALYs but has not made a decision as to whether they will adjust their methodology. Click here to view the letter from almost 50 advocacy groups asking the HERC to stop using QALYs. Click here to view testimony from PIPC Chairman Coelho to the Oregon HERC expressing his support for the Americans with Disabilities Act. Click here to view the options that continue to be under consideration by the HERC to continue using QALYs. Click here to view all of the comments shared with PIPC.

International News: What Happens in Countries Using QALYs and Cost-Based Thresholds?

Other countries are often referenced as examples of how the use of QALYs or similar cost-based thresholds impact access to care.
 
  • Australia: MS patients in Australia face limited choices with respect to effective treatments covered, and some are forced to raise money for treatment overseas.
 
  • U.K: The family of a patient with MS has had to turn to crowdfunding for treatment that is not funded through the NHS. 

ICER's QALY-Based Study Topics
 
The Institute for Clinical Economic Review (ICER) conducts cost effectiveness studies for insurers using the cost-per-QALY methodology. ICER provides guidance on its website for patients and patient advocates to provide direct input related to their experiences with the disease. Click here to provide patient input. Click here to view the topics and deadlines.
 
  • Paroxysmal Nocturnal Hemoglobinuria: Draft Scoping Document Available. Comments due August 14, 2023.
 
  • Schizophrenia: Draft Scoping Document available. Comments due on July 26, 2023.
 
  • Metachromatic Leukodystrophy: Draft Evidence Report now available.
 
  • Pulmonary Arterial Hypertension: Draft Scoping Document available. Open for comments until June 5, 2023.
 
  • Sickle Cell Disease: Evidence Report Available. California Technology Assessment Forum (CTAF) to meet on July 27, 2023, to review.
 
  • Non-Alcoholic Steatohepatitis: Final Evidence Report now available.

Upcoming Events and Webinars

2023 PCORI Annual Meeting
October 4-5, 2023
Click here to view.
 
Real World Evidence Conference
October 16-17, 2023
Click here to view.

Medical Journal Articles

NEW: A Clinical Pathway to Well-Being: Putting Patient Priorities at the Center of Care. Click here to read the article.
 
Comparative Effectiveness of Treatments for Rheumatoid Arthritis in Clinical Practice: A Systematic Review. Click here to read the article.
 
QALYs: The Math Doesn’t Work. Click here to read the article.
 
The Implementation of Value-Based Frameworks, Clinical Care Pathways, and Alternative Payment Models for Cancer Care in the United States. Click here to view.
 
Perspectives on Patient-Reported Outcome Data After Treatment Discontinuation in Cancer Clinical Trials. Click here to view.
 
The Implementation of Value-Based Frameworks, Clinical Care Pathways, and Alternative Payment Models for Cancer Care in the United States. Click here to view.
 
Federal Data for Conducting Patient-Centered Outcomes Research on Economic Outcomes. Click here to view.
 
Patient-Reported Outcomes for People with Diabetes: What and How to Measure? A Narrative Review. Click here to view.
 
Patient Engagement in Research; Benefits, Challenges, Importance, and Implications. Click here to view.
 
The Opportunity for Greater Patient and Public Involvement and Engagement in Drug Development and Regulation. Click here to view.

AHRQ Effective Program Updates
 
Technical Brief: Measuring Healthcare Organization Characteristics in Cancer Care Delivery Research. Click here to view.
 
Systematic Review: Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-analysis. Click here to view.
 
Draft Report: Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare. Click here to view.
 
Systematic Review: Partian Breast Irradiation for Breast Cancer. Click here to view.
 
Systematic Review: Use of Telehealth During the COVID-19 Era. Click here to view.
 
Research Report: Analysis of Requirements for Coverage with Evidence Development (CED) - Topic Refinement. Click here to view.
 
Technical Brief: Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. Click here to view.
 
Systematic Review: Management of Infantile Epilepsies. Click here to view.

Comments are closed.

    Topics

    All
    Alternative Payment Models
    Chairman's Corner
    Patient Centered Research
    PIPC In The News
    PIPC Patient Blog
    PIPC Weekly Update
    Press Releases
    The Data Mine
    Value Frameworks

    Archives

    June 2025
    May 2025
    April 2025
    March 2025
    February 2025
    January 2025
    December 2024
    November 2024
    October 2024
    September 2024
    August 2024
    July 2024
    June 2024
    May 2024
    April 2024
    March 2024
    February 2024
    January 2024
    December 2023
    November 2023
    October 2023
    September 2023
    August 2023
    July 2023
    June 2023
    May 2023
    April 2023
    March 2023
    February 2023
    January 2023
    December 2022
    November 2022
    October 2022
    September 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    April 2013
    March 2013
    December 2012
    November 2012
    February 2012
    September 2011
    August 2011
    July 2011
    May 2011
    March 2011
    November 2010
    October 2010
    September 2010
    August 2010
    April 2010
    March 2010
    February 2010
    December 2009
    September 2009
    July 2009
    June 2009
    May 2009
    February 2009
    January 2009
    December 2008

Powered by Create your own unique website with customizable templates.