Feb 8, 2024 - Health

House approves ban on disputed measure for valuing treatments

Illustration of a hand holding an approval stamp hovering over a pill.

Illustration: Aïda Amer/Axios

A divided House of Representatives on Wednesday endorsed banning quality-adjusted life years from being used as a metric for determining a drug's value in federal health programs.

Why it matters: QALYs are viewed as a key tool in comparative effectiveness studies, but have been held up as discriminatory against people with disabilities — and are unevenly applied across federal programs.

  • They are used to calculate how many years a drug could help prolong a person's life — but factor how a patient feels during those extra years to determine if a medicine is worth the price.
  • That's raised sensitive bioethics questions, such as whether it's worth less to treat a person with a serious developmental disability.

The Biden administration this week came out against the ban, characterizing it as a backdoor attempt to weaken public health efforts, while noting there already are prohibitions against using QALYs in Medicare as part of the Affordable Care Act and the Inflation Reduction Act.

  • Rep. Frank Pallone, the top Democrat on the House Energy and Commerce Committee, argued on Wednesday that the ban would undermine federal efforts to lower prescription drug costs and give drug companies an opening to legally challenge efforts to reduce costs.
  • Such opposition could doom the ban's prospects of being taken up in the Senate.

Driving the news: The measure passed in a party-line vote of 211–208 and marked a victory for Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.), who's made it a priority.

  • Disability groups and figures including ex-Democratic Rep. Tony Coelho, a primary sponsor of the Americans with Disabilities Act, argued QALYs lowball the value of treating patients with heart disease, ALS, or sickle cell disease and lead insurers to give them less priority for coverage.
  • McMorris Rodgers cited her 16-year-old son, who has Down syndrome, while arguing Wednesday the metric discounts unique circumstances and health conditions and the doctor's judgment from deciding what's best for the patient.
  • Experts have said they're unaware of instances in which QALYs are the only criterion for determining a drug's value.

A version of this story was published first on Axios Pro. Unlock more news like this by talking to our sales team.

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