A health cost-effectiveness bill teeters

The ideas and innovators shaping health care

Mar 27, 2023 View in browser   By Ben Leonard, Ruth Reader and Erin Schumaker WASHINGTON WATCH House Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) was a no on a bill to bar federal agencies from using quality-adjusted life years. | Francis Chung/E&E News It looked like Congress might bar federal agencies from using quality-adjusted life years, a metric used to evaluate the cost-effectiveness of drugs and treatments after top Democrats on the Energy and Commerce committee signaled openness to a deal with Republicans, both saying the metric is discriminatory. But when the House Energy and Commerce Committee considered a bill by its chair, Cathy McMorris Rodgers (R-Wash.), to bar its use, the ranking member Frank Pallone (D-N.J.) was a no, along with 19 other Democrats on the panel. The vote on Friday to advance the measure to the full House was 27-20, with Rep. Anna Eshoo (D-Calif.), the chair of the panel’s health subcommittee voting present. She expressed optimism that a deal could still come. Rodgers said the widely used metric undervalues the benefits that therapies provide to people who have disabilities or are elderly. Pallone thinks the language is overbroad and, if enacted, the bill would interfere with upcoming Medicare drug-price negotiations by prohibiting other measures of cost-effectiveness. During a subcommittee markup earlier this month, though, Democrats suggested a compromise was close. During the full committee’s consideration Friday, Pallone said those negotiations have fallen short. “I need assurances that nothing in the legislation would go beyond banning the use of QALYs or could be used to delay or disrupt the implementation of the drug price negotiations,” Pallone said. Why it matters: Health industry and patient advocacy groups are divided on the legislation. The Campaign for Sustainable Rx Pricing, whose members include AARP, insurer trade group AHIP, the American Hospital Association and the Pharmaceutical Care Management Association, which represents pharmacy benefit managers, wrote to Rodgers opposing the legislation. The coalition argued it would restrict the information that patients and providers would have about treatment values and effectiveness. They also said it would put unnecessary restrictions on drug pricing negotiations. Still, groups representing people with disabilities, including the National Down Syndrome Society, among others, support the bill. And PhRMA, the trade group for brand name drugmakers, has raised concerns that QALYs could discriminate against “disadvantaged communities” and reinforce health disparities. However, a PhRMA spokesperson said that the group hasn’t taken a position on the bill. WELCOME TO FUTURE PULSE Tidal Basin in Washington, D.C. during peak cherry blossom bloom on March 24, 2023. | Carmen Paun This is where we explore the ideas and innovators shaping health care. Who would ever want to sniff armpit sweat? People willing to treat their anxiety, Swedish researchers think. They believe body odor might communicate one's emotional state and even elicit similar responses in others who smell it. Will the study pass the sniff test? Today on our Pulse Check podcast, host Carmen Paun talks with Erin, who discusses a U.S. Department of Defense–funded $3 million collaboration between UMass Lowell and Soar Technology to find the best human decision-making attributes artificial intelligence can imitate and the value of training AI to handle situations in which there are no clear right or wrong answers. Listen to today’s Pulse Check podcast   JOIN POLITICO ON 4/5 FOR THE 2023 RECAST POWER LIST: America’s demographics and power dynamics are changing — and POLITICO is recasting how it covers the intersection of race, identity, politics and policy. Join us for a conversation on the themes of the 2023 Recast Power List that will examine America’s decision-making tables, who gets to sit at them, and the challenges that still need to be addressed. REGISTER HERE.     TECH MAZE A bipartisan alliance tested a single sign-on that would enable patients to access their data across platforms in one step. | Sean Gallup/Getty Images The CARIN Alliance and the Department of Health and Human Services released a report buttressing the case for creating a single-sign-on system to facilitate patients’ access to their medical records. The bipartisan alliance — formed in 2016 by former HHS Secretary Mike Leavitt, former U.S. Chief Technology Officer Aneesh Chopra and two former national coordinators for health IT to improve data access — recruited companies and health systems to collaborate on solutions. The group tested a single sign-on that would enable patients to access their data across platforms in one step. The system was simple to use, and patients could be matched with their data, said the report. More than 25 organizations, including CVS Health and Kaiser Permanente, participated in the testing. Why it matters: The 21st Century Cures Act, which Congress passed in 2016, sought to give patients easier access to their records, but health care organizations continue to have trouble sharing data. If patients could sign up for the system, it could eliminate their need to verify their identity at each patient portal they visit. What’s next: The report called for more testing involving more patients and research on different financial models.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     WORKFORCE Mental health providers would like to continue telehealth services across state borders. | Business Wire Widespread adoption of telehealth during the pandemic has called into question state-licensing rules that have traditionally limited where doctors can practice. States waived those rules after Covid arrived, and mental health providers would like to keep it that way, according to a survey of 205 practitioners using telemedicine. The survey was conducted by Alma, a digital health company that connects people with therapists. Alma found that nearly 9 in 10 of its therapists want to be able to provide care across the country if their license enabled them to provide care nationwide. The doctors acknowledged it would be good for business: — 12 percent said the relaxation of state licensing rules would increase their revenue by more than 50 percent. — 59 percent said it would increase their revenue by 20 to 50 percent. — 29 percent said it would increase revenue by less than 20 percent. Customer clamor: Alma founder Harry Ritter told Ben that relaxed rules would be a win for patients, too, expanding access to care. Most mental health care is now delivered virtually, and more than 90 percent of Alma’s providers offer telemedicine, Ritter said. State patchwork: Currently, states have divergent policies on whether doctors can serve telemedicine patients in states where they aren’t licensed. Millions have lost access to virtual care across state lines as eased pandemic rules have ended. “It’s one of these legacy issues that still exist,” said Ritter. What’s next: It’s unclear whether the medical establishment can agree on what to do, given the conflict among the telehealth industry and the American Medical Association and state medical boards over how to handle the issue. HHS Secretary Xavier Becerra has called on Congress to work out an interstate licensing system.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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