This informal state-only call will consider the potential state implications of HR 485, The Protecting Health Care for All Patients Act of 2023.

HR 485 passed out of the House Energy and Commerce Committee on March 24, 2023, and may be brought to the House floor for a vote soon. This bill would prohibit all federal agencies and states from using quality-adjusted life years (QALYs) — and similar measures — to determine relevant thresholds for coverage, reimbursements, or incentive programs.

QALYs are one of multiple comparative effectiveness tools that a state might use in assessing the value of a prescription drug. QALYs have been controversial for assigning different weight to different lives based on quality of life. In response, similar tools have been developed that place equal value on all lives. 

HR485 includes broad language that bans not just QALYs, but also “similar measures.” Such a broad ban could have unintended impacts on states if other, non-discriminatory methods of comparative effectiveness research become prohibited. For example, an overly broad ban could impede states’ negotiation of supplemental rebates and Medicaid formulary management. 

Please note: This call is open to state officials only.