Using traditional HTAs to determine coverage threatens patient access to medicine

Katie Koziara
Katie Koziara December 14, 2022

Using traditional HTAs to determine coverage threatens patient access to medicine.

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Concerns about the cost of health care have led to calls for the use of health technology assessments or HTAs by the federal government. This would allow government agencies to make important decisions about patient access to health care based on their determination of the value of new tests and treatments. In this series, we’ll explore how this controversial practice:

  • Ignore differences in diverse populations
  • Limit access to beneficial treatment options  
  • Reinforce — rather than reduce — health disparities

As we work to make our health care system more resilient, affordable and equitable, every reform must pass a simple test: Does it protect patient access? Extreme policies based on political rhetoric won’t solve the underlying health care challenges facing patients.

The recently enacted Inflation Reduction Act gives CMS unprecedented new authority to use comparative effectiveness research — including HTAs — to make centralized judgments about the value of certain treatments. It’s vital for policymakers to reduce these risks. Not only do HTAs exacerbate health disparities, rely on a non-existent hypothetical “average” patient and ignore patient perspectives, but they also threaten access to life-saving care.

Health plans, government programs and other payers risk restricting access to treatments that may be valuable to populations already impacted by inequities if they rely on HTA to determine a medicines value:

  • Traditional HTAs, such as those used by ICER, ignore differences in disease burden and treatment effectiveness across patient populations. They also can ignore what communities value, which may depend on differences in culture, preferences and past experiences within the health care system.

  • For example, Black Americans are more likely to be exposed to a higher degree of air pollution, and air pollution is associated with increased risk for COVID-19 associated mortality. Medicines that can reduce complications from COVID-19 may result in higher value for Black Americans living in areas of high air pollution and could also reduce disparities in lung health.

  • We know how this story ends — by looking at other countries that already rely on HTA standards. Patients in these countries experience access restrictions to medicines to treat cancer, diabetes and other diseases. These are some of the very same diseases that disproportionately impact communities of color in the United States.

As we work to improve our health care system, only patient-centered solutions will help those most in need. Value assessments offer one tool to support value in health care, but they should not be used to impose one-size-fits-all standards of care or deny patients access to life-saving treatments.

Learn more at phrma.org/policy-issues/value-assessment

Topics: Value Assessment, Health Equity