A Centers for Medicare and Medicaid Services’ proposed rule would use a metric for rationing health care that was banned following the Obamacare death-panel debate.
The controversial rule, which has a public comment period ending May 9, calls for changes to Medicare Part B’s drug payment model and would use reports incorporating data using quality-adjusted life year (QALYs), a tool used for rationing health care by measuring disease burden.
The changes have received pushback from both sides of the political spectrum over its potential to limit to drug access for the elderly and physically disabled.
The proposal’s second stage suggests testing alternative drug payments using indications-based pricing, which would look at the cost-effectiveness of the medications. The Institute for Clinical and Economic Review (ICER) often uses QALYs, which measures disease burden and quality of life, when working out its data on differences in drug costs.
“ICER’s reports reflect the dependence of the value of medications on evidence available for certain target populations,” the rule reads. “We propose to use indications-based pricing where appropriately supported by published studies and reviews or evidenced-based clinical practice guidelines, such as the ICER reports, to more closely align drug payment with outcomes for a particular clinical indication.”
Critics, including patient advocacy groups like the Partnership to Improve Patient Care (PIPC), say the rule allows Washington bureaucrats to use an algorithm that fails to take real-life consequences into account – like doctors being pushed toward the cheaper yet possibly less effective treatment option.
In a recent piece for US News and World Report, former Democratic Congressman Dan Maffi –who supported Obamacare – said it would unravel the safeguards put in place by the Affordable Care Act and eventually lead to higher costs.
“The Affordable Care Act banned Medicare’s use of this metric because it would otherwise be deciding that one life is more important than another,” he wrote in the article. “Through the institute’s use of quality-adjusted life years as a metric, the insurance industry is already violating the spirit, if not the letter, of the provisions of the health care law, written to ensure there would be nothing like so-called death panels condoned by the law.”
Lawmakers in both chambers have recently called on the administration to withdraw the rule.
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