Medicaid Use Of QALYs As Basis Of Drug Coverage Restrictions Would Be Barred By HHS Proposal
Prohibition by Health and Human Services Department Office of Civil Rights would apply to use of such metrics in determining formulary access but not to use in ‘academic’ research.
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The government’s rush to stand up the negotiation program by the fall likely means an approach to cost effectiveness will be left out of at least the first cycle. But it could be incorporated over time.
No one seems eager to defend the QALY tool as a House Republican bill seeks to prohibit any federal agency from using Quality Adjusted Life Years as a formula to determine pricing.
Bills to narrow the Medicare price negotiation program’s reach generated extensive discussion at the hearing.