Pharmaceutical Analyses Based on the QALY Violate Disability Nondiscrimination Law

September 21, 2021
Over the past several decades, the debate over the cost of pharmaceuticals and the perceived “value” of certain drug treatments has amplified. In pursuit of cost containment, policymakers have wrestled with the concept of cost-effectiveness and sought measures by which to guide health care payers in their decisionmaking regarding formularies and utilization management. One measure in use by many payers is the Quality-Adjusted Life Year (“QALY”). The QALY is a metric that, in theory, measures the degree to which a drug or therapy extends life and improves quality of life. The QALY is used to develop guidelines on the economic “value” of a given pharmaceutical, which then informs a payer’s decision of whether to cover such drug and, if so, under what terms. Unfortunately, the QALY relies on a set of discriminatory assumptions that devalue life with a disability, disadvantaging people with disabilities seeking to access care based on subjective assessments of quality of life. This paper details how the use of the QALY violates disability nondiscrimination law. […], September 21, 2021
Over the past several decades, the debate over the cost of pharmaceuticals and the perceived “value” of certain drug treatments has amplified. In pursuit of cost containment, policymakers have wrestled with the concept of cost-effectiveness and sought measures by which to guide health care payers in their decisionmaking regarding formularies and utilization management. One measure in use by many payers is the Quality-Adjusted Life Year (“QALY”). The QALY is a metric that, in theory, measures the degree to which a drug or therapy extends life and improves quality of life. The QALY is used to develop guidelines on the economic “value” of a given pharmaceutical, which then informs a payer’s decision of whether to cover such drug and, if so, under what terms. Unfortunately, the QALY relies on a set of discriminatory assumptions that devalue life with a disability, disadvantaging people with disabilities seeking to access care based on subjective assessments of quality of life. This paper details how the use of the QALY violates disability nondiscrimination law. […],