On Dec. 24, 2019, Aimed Alliance joined a coalition of advocacy organizations in a letter to the Centers for Medicare & Medicaid Services (CMS), requesting that the agency reject Tennessee’s proposed amendment to the state’s TennCare Demonstration. This amendment proposes to implement a closed formulary in the state’s Medicaid program, which would allow the value of medications to be determined using cost-effectiveness analyses that rely on value assessment metrics like the Quality-Adjusted Life Year (QALY).
This letter calls attention to the fact that the National Council on Disability (NCD) recently concluded that the QALY metric places a lower value on treatments that extend the lives of people with chronic illnesses and disabilities. For this reason, NCD recently cautioned against using the QALY metric to measure the cost-effectiveness of treatments. The letter asserts that allowing a closed formulary that relies on QALY to determine the cost-effectiveness of available treatments will lead to discrimination and reduced access to care.
Read the letter to learn more.