Some members of Congress are advancing health policy under the umbrella of H.R. 3, which fails to heed the most important lessons of our most recent public health response while simultaneously ignoring the needs of our most vulnerable patient populations. H.R. 3 ties the U.S. prescription drug market to a reference list derived from a group of foreign countries. In so doing, it links U.S. prescription drug policy to the “Quality Adjusted Life Year,” or QALY, measurements for deciding clinical access to therapeutics.
A QALY measurement scores the therapeutic value of a given medicine by calculating how many healthy life years it might add to a patient’s life. In the countries that H.R. 3 would have the U.S. emulate, insurers and governments often exclude medicines from their formularies that don’t have high QALY scores. This has the effect of devaluing treatments for those who are chronically ill or who have disabilities.
If the pandemic has taught us anything, it’s that we need to take extra care of communities that have been left behind. Relying on a formulary system that disadvantages our most vulnerable populations undervalues vulnerable Americans, in pursuit of cost savings that mostly accrue to insurance companies.
H.R. 3 misses the mark in appropriately balancing our country’s needs. We can do better.