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Published March 24, 2023
The House Energy & Commerce (E&C) Committee voted today to report H.R. 485, the Protecting Health Care for All Patients Act of 2023, out of committee for consideration by the full U.S. House of Representatives. H.R. 485 would prohibit all federal healthcare programs, including but not limited to Medicare Advantage, Medicaid, and Veterans Administration, from utilizing the quality-adjusted life year (QALY) or similar metrics in coverage, formulary, or reimbursement decisions.
The Alliance for Aging Research has long expressed concern about the discriminatory impacts of the QALY and similar metrics on older adults and has supported wider adoption of the QALY ban in Medicare that was originally included in the Affordable Care Act.
In response to the committee vote, Michael Ward, Vice President of Public Policy and Government Relations, said:
“The Alliance thanks the E&C Committee, including Chair Rodgers, for voting to bring H.R. 485 forward to the full U.S. House. The bill makes clear that discriminatory methodologies have no place in healthcare.
At the same time, we are concerned that groups and individuals aligned with the Institute for Clinical and Economic Review (ICER) – which uses QALYs and developed the estimated value of life-years gained (evLYG) – have been sowing confusion around the use of QALYs and the evLYG. Both measures consider treatments that extend life – especially in healthier, young people – as more cost-effective than treatments that primarily improve quality of life. This disincentivizes investment in conditions that disproportionately impact the aging population, as these methodologies assume older adults have fewer life-years to potentially gain.
Banning the use of discriminatory measures including the QALY and evLYG would still permit the use of comparative effectiveness research, the development of which the Alliance has long advocated for through our support for groups such as the Patient-Centered Outcomes Research Institute (PCORI).
Combating discrimination should not only be done when it is easy or politically expedient. We encourage bipartisan support for this important legislation and look forward to working to help ensure the passage of H.R. 485.”