The second wave of COVID-19 has arrived with a vengeance. For the first time, the United States reported over 170,000 new cases in a single day. The seven-day rolling average now exceeds 136,000.
But there's hope on the horizon. Pfizer and Moderna just announced their experimental vaccines that proved more than 90 percent effective in clinical trials. The companies could start inoculating tens of millions of Americans as early as December.
People in the highest risk categories — namely, health care workers and those with chronic illnesses and disabilities — will receive prioritized access to these vaccines. That's as it should be. These groups have suffered immensely over the past year. Putting them at the front of the line for a vaccine is a way to collectively acknowledge that their lives matter.
But unfortunately, when it comes to diseases other than COVID-19, society doesn't show nearly the same level of concern for people with disabilities and chronic illnesses. In fact, many self-styled health care experts have proposed "reforms" that would effectively limit these individuals’ access to treatments. That's wrong, plain and simple.
By now, it's well known that COVID-19 disproportionately harms people with pre-existing conditions and disabilities. Of the roughly 250,000 Americans who've lost their lives, 94 percent had another condition listed as a factor in their cause of death. COVID-19 patients with intellectual or developmental disabilities have died from the virus at roughly twice the rate of the general patient population.
These vulnerable patients could soon face even more challenges if health insurers listen to groups like the Institute for Clinical and Economic Review (ICER).
Cost arbiter biased?
The influential nonprofit has appointed itself as an arbiter of new drugs' cost-effectiveness. ICER recommends a "fair price" for medications based on the analyses it performs. Already, some insurance companies, as well as the Department of Veterans Affairs and New York's Medicaid program, use these analyses to help decide which drugs to cover and how much they should pay.
To conduct these cost-benefit analyses, ICER uses a controversial metric called a "quality-adjusted life year," or QALY. A treatment that adds a year of perfect health to a patient's life provides one QALY. And the more QALYs a drug generates per dollar, the more valuable ICER considers it.
In theory, QALY assessments provide an objective way to quantify a drug's effectiveness — and ensure that patients, insurers, and taxpayers are getting a good bang for their buck.
But in practice, these assessments discriminate against patients with disabilities and chronic illnesses. That's because patients with certain chronic diseases and disabilities may never achieve a full QALY. A drug could completely alleviate the patient's symptoms — but wouldn't deliver a full QALY. Although the patient's symptoms may be addressed, they may still find themselves with limited function.
In other words, ICER uses its QALY metric to devalue the lives and well-being of vulnerable populations. And ICER's clout cannot be underestimated. If it considers a drug to not be cost-effective, insurers may listen and deny the medication to those who need it most.
The dangerous consequences of ICER's pseudoscientific evaluations don't end there. By placing such a low value on these treatments, ICER discourages biopharmaceutical firms from investing in drugs that disproportionately benefit Americans with disabilities. Instead, their money would be better spent developing treatments that extend the lives of people already in relatively good health.
ICER isn't alone in signaling that drug companies shouldn't waste their time on treatments for Americans with disabilities. The outgoing Trump administration is still pressing forward with its efforts to tie Medicare drug reimbursements to the artificially low price of drugs in Canada and Europe, where price controls have long restricted patients' access to new medicines. If the administration's changes were implemented, investors could pull the plug on research projects targeting rare diseases.
Americans overwhelmingly agree that the most vulnerable patients deserve priority access to COVID-19 therapeutics and vaccines. It's time for people to recognize that these vulnerable populations need, and deserve, access to treatments for other conditions as well.
Angela F. Williams is president and CEO of Easterseals, a leading provider of services for people with disabilities, veterans and seniors. The opinions are the writer's.
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