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What We’re Reading: House Passes QALY Ban; Proposed MA Rates Criticized; Long COVID Treatment Success


House Republicans voted to ban quality-adjusted life years (QALYs) from being used as a drug pricing metric in federal health programs; insurance executives disapproved of newly proposed 2025 Medicare Advantage (MA) rates; patients with long COVID enrolled in an online exercise program said their health improved more than people who received standard care.

House Approves Ban on QALY Use in Federal Programs

In a party line vote, House Republicans voted to ban quality-adjusted life years (QALYs) from being used as a drug pricing metric in federal health programs, according to Fierce Healthcare. The Protecting Health Care for All Patients Act, which passed with a 211 to 208 vote, would end the use of QALYs and other metrics in federal health programs, like Medicare. The Biden administration spoke out against the ban, describing it as an attempt to weaken public health efforts, noting that there are already bans against using QALYs in Medicare as part of the Inflation Reduction Act and the Affordable Care Act. The bill will now head to the Senate, but it is unlikely to pass if party line voting continues; Rep Frank Pallone (D, New Jersey), the top Democrat on the House Energy and Commerce Committee, argued that the ban would undermine federal efforts to lower prescription drug costs, giving drug companies an opening to legally challenge efforts to reduce costs. If passed by the Senate, the law would take effect in January 2025.

Health Insurers Disapprove of Proposed MA Rates

CVS Health and Centene executives said that newly proposed 2025 Medicare Advantage (MA) rates are not sufficient, explaining that they may reduce benefits if the federal government finalizes the rates as is, according to Axios. Last week, Medicare proposed cutting base payments to MA plans by 0.16% next year, but officials argue that plans would still receive $16 billion more when adjusted for customer health. Despite this, insurers said they are expecting a deeper net cut, especially due to rising medical costs; they also raised concerns about the changes to Medicare Part D that include caps on seniors’ drug expenses, which will require additional funding to cover member benefits provided and the increased risk that plans are assuming. Consequently, CVS and Centene executives announced this week that they would adjust their plans to account for the proposed rates. The final 2025 rates are expected by early April, with potential adjustments based on updated health care use information.

Long COVID Study Tests Psychological Counseling, Exercises as a Treatment Option

A recent study published in BMJ reported that people with long COVID who enrolled in an online exercise program said their health improved more than those who received standard care, according to Stat. The study divided subjects who had been discharged 3 months earlier from COVID-19 hospitalizations into 2 groups. One group received one-on-one standard care sessions, while the other had sessions devoted to planning psychological counseling and exercise sessions. Patients attended these weekly sessions online and engaged in body weight exercises, like steps, squats, and chair-based movements, while supervised by a trained physiotherapist or exercise physiologist; the goal was to build confidence to engage in physical activity by helping patients improve strength, endurance, coordination, balance, and cardiovascular fitness. After 3 months, 17% of people in the intervention group reported that their overall health was “much better” compared with 8% in the usual care group. Also, after 12 months, depression was lower in the intervention group.

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