Trump’s Drug Price Plan Would Hurt the Disabled
Potential drawbacks associated with President Trump’s proposed “most favored nation” drug-pricing policy have been outlined in these pages and elsewhere. One less-explored aspect is that the president’s proposal would harm Americans with disabilities. It effectively imports foreign countries’ discrimination against people with disabilities in ways that likely violate federal law.
The president’s call on pharmaceutical companies to lower their American prices to the lowest among developed nations doesn’t take into account that many of those countries use some version of the quality-adjusted life year, or QALY, to help determine drug prices. The QALY is a calculation of quality and length of life expected after treatment, such as after taking a new medicine. In England, for example, the National Institute for Health and Care Excellence uses the QALY measure to judge cost-effectiveness in deciding which pharmaceuticals the National Health Service will cover.
But as a 2019 report by the National Council on Disability, a U.S. advisory agency, demonstrated, the QALY measure relies on a discriminatory premise: that extending the life of a person with a disability delivers less value than extending the life of a person in “perfect” health. People without disabilities often view disabilities negatively. The NCD quotes one study, based in the U.K., that said nearly a quarter of respondents would view living the rest of their lives in a wheelchair as a fate worse than death. Most surveys, however, show that people with disabilities report similar life satisfaction levels to those without them.
Because QALYs perpetuate negative stereotypes about people with disabilities, using them to determine drug prices—as Britain, Canada, Ireland and some other developed countries do—would codify that discrimination in ways that violate the Americans with Disabilities Act. For this reason, NCD recommended that Medicare and Medicaid “should refrain from pursuing” policies “that attempt to model US [drug] pricing after the pricing in other countries, which may heavily rely on QALYs and often deny people with disabilities access to needed care.”
In its 2019 report, NCD called on the first Trump administration to rescind its proposal for an international drug-pricing mechanism because of its discriminatory implications. That same year, a coalition of disability groups similarly called on congressional Democrats to remove references to international prices from draft drug-pricing legislation over concerns that the mechanism would “effectively import a QALY-based and discriminatory system from abroad.”
In recent years, both Democrats and Republicans have tried to prevent the discriminatory QALY measure from taking root in the U.S. In the 2022 Inflation Reduction Act, Democrats modified their drug-pricing “negotiation” mechanism to remove references to international prices, likely due to concerns raised by disability groups. In 2010, ObamaCare prohibited Medicare from using any research “that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value.” More recently, House Republicans last February passed legislation extending the prohibition on the use of QALYs, or any similar measure, to all federal health programs.
By applying foreign discrimination to American drug prices, President Trump’s proposal would alter a growing consensus against the QALY measure. It would also subject his administration to lawsuits under the Americans with Disabilities Act. In denying Oregon a Medicaid waiver in 1992 because its proposal “values the life of a person with a disability less than the life of a person without a disability,” Secretary of Health and Human Services Louis Sullivan wrote that “Oregon would have been sued if we had approved the waiver, preventing Oregon from implementing the plan for years.” Mr. Trump’s proposal may face the same fate.
The American people deserve policies that will bring down drug prices while fostering innovation. Importing a discriminatory and arguably illegal framework that harms the most vulnerable isn’t the right approach.
This post was originally published at The Wall Street Journal.