Flawed assessments of a medicine’s value jeopardize patient access, says PhRMA

Under the US Biden administration’s Inflation Reduction Act (IRA), government bureaucrats will unilaterally decide how much a treatment selected for price setting is worth.

According to US trade group Pharmaceutical Research and Manufacturers of America’s (PhRMA) Nicole Longo, deputy vice president of public affairs focusing on Medicare, to make matters worse, the price setting process is a black box.

No one knows how exactly the government is determining the value of medicines selected for price setting or how much input it will use from patients, providers and other stakeholders - but, alarmingly, we do know they expressed significant interest in using flawed cost-effectiveness metrics, she noted. In the 2023 final guidance for the first year of the price setting process, the Centers for Medicare & Medicaid Services (CMS) stated that it: “…will review and consider cost-effectiveness measures and studies that use such measures for initial price applicability year 2026.”