Healthcare affordability is America’s number one financial concern. According to new polling from the Kaiser Family Foundation, roughly two-thirds of U.S. adults worry about being able to afford the care their families need.
By Gary Puckrein
Yet in the search for solutions, the federal government appears to be heading in the wrong direction. Policymakers are considering drug pricing models that risk erecting new barriers to care and worsening health outcomes — without delivering value to patients.
The models at issue are the Global Benchmark for Efficient Drug Pricing Model (GLOBE) and Guarding U.S. Medicare Against Rising Drug Costs Model (GUARD). Both would link Medicare payments to prices set in countries that operate under healthcare systems vastly different from our own. Many rely on strict price controls and coverage limits that impede access to new, more effective therapies. Bringing those constraints into Medicare would affect all beneficiaries, as well as their families and communities.
The concern begins with how the health systems in these reference countries assess value. Their pricing approaches often depend on cost-effectiveness frameworks like the quality-adjusted life year (QALY), that fail to reflect the realities — and health needs — of the full patient community.
These models rely on clinical data that frequently underrepresent subsets of the American population — including older adults, people living with disabilities and chronic diseases, and those in rural communities. As a result, they can fail to factor in differences in co-occurring conditions, illness progression, overall health status, and therapeutic response.
For millions of patients who rely upon Medicare, the consequences would be significant. Any new barriers to timely treatment increase the likelihood of complications, disease progression, and avoidable declines in health. Communities who have a higher prevalence of conditions such as HIV/AIDS, diabetes, asthma, and several forms of cancer, would be among the most vulnerable.
Patient risks for preventable illness and complications would be exacerbated by the way these models would alter incentives within Medicare. By tying payments to lower benchmarks, they could skew payer incentives toward payer-defined cost reduction. That shift would undermine clinical decision-making informed by quality metrics that reflect patients’ needs.
And, crucially, these models would fail to deliver to patients the financial relief they promise. Analysis indicates they won’t lower what most patients pay out of pocket for treatment.
If the aim is to improve healthcare affordability and accessibility, policymakers should focus on the actual barriers patients encounter every day — including coverage limitations and administrative procedures that prevent patients from accessing timely care.
Federal and state policymakers ought to advocate for a forward-looking, patient-centered realignment of America’s health research, delivery, and financing systems.
The benefits of this approach would be shared broadly. By investing in patients across the full continuum of care, we can improve health outcomes while reducing long-term healthcare costs.
Gary A. Puckrein is president and chief executive officer of the National Minority Quality Forum. This article originally appeared in the Washington Examiner.
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