QALY Ban Passes House 😎

Hannah Wolf  0:03  
Welcome to Healthcare Policy Pop, I'm Hannah Woulfe. It's Thursday, February 8, 2024. Today's pop topics: a big step toward finally shutting down the QALY. HR 485 officially passed the House on Wednesday morning and a major win for patients across the country. In a statement, Patients Rising CEO Terry Wilcox reflected on the years of work by patients and disabled people to get Congress to move on the QALY. Wilcox said quote, "while we are disappointed that the vote was along party lines, we celebrate a long awaited open door to equal value in the eyes of the federal government. People with disabilities, the elderly, and those living with life challenging illnesses are no less worthy than perfectly healthy individuals, our lives matter." As all of us was developing, we sat down with Bill Smith, a senior fellow at the Pioneer Institute to discuss what all of this means for patients, and why he sees it as a metric of the past.

Bill Smith  1:06  
It discriminates against people living with disabilities, people with cancer, people on rare disease drugs. There's a lot of flaws in that methodology. So essentially, what this bill does is it bans the use of the QALY in federal programs. So if you're a Medicaid Medical Director, you can't use the QALY to rate drug therapies that might appear. If you're in the VA, you can't use the QALY to rate surgeries.

Hannah Wolf  1:32  
Smith says by using this metric patients are destined to be denied.

Bill Smith  1:37  
The thing about it is, the game is rigged, because if you say that a human life is worth $100 million, then you you end up concluding that every drug should be paid for and is cost effective. If you argue that a human life is only worth $1, then virtually no drug can be cost effective. So they rigged the game basically. And they can choose the value of human life and they can go up or down in order to rate drugs, knowing that they're going to come out as either cost effective or not cost effective, depending on where they pick that threshold. Although

Hannah Wolf  2:13  
Although there is a long way to go for this bill to become law, Smith believes this is one battle patients are winning.

Bill Smith  2:20  
I think the QALY is playing defence. And there's bipartisan concern about it. Even the Biden administration has in a recent report argued that the QALY should not be used in the Medicare program to rate drug therapies because it discriminates against people living with disabilities. So you're seeing a bipartisan consensus in the US that the QALY should not be used. And you know, this House vote is just another indicator of it.

Hannah Wolf  2:48  
Smith is encouraged about what this bill could mean for the future.

Bill Smith  2:53  
I'm kind of heartened by this, because the QALY has been adopted widely in Europe, most of the major countries with the exception of Germany, use the QALY: Great Britain, France, Spain, Italy, you name it, and the United States is standing up in the face of that and saying no, we're not going to do it. We're going to protect patients. And we're not going to use this QALY. So I think this is a good sign for the United States political culture.

Hannah Wolf  3:23  
Patients Rising remains committed to working with all parties in the Senate to make sure patients are valued equally in the eyes of the federal government. We also want to extend our gratitude to the ENC chair McMorris Rogers for her leadership and moving this bill to the House floor. That's all for today. We're back on Tuesday for another Healthcare Policy Pop, a resource of Patients Rising Now. I'm Hannah Woulfe, have a great day.