Notice of Funding Opportunity: State’s use of Quality-Adjusted Life Year (QALY) - Based Cost-Effectiveness Reports to Inform Medicaid Coverage for Prescription Drugs

The National Council on Disability (NCD) seeks proposals for a report that examines the extent of state’s use of QALY-based cost-effectiveness studies issued by the Institute for Clinical and Economic Review (ICER) or international drug prices set in reliance on QALY based cost-effectiveness research, to inform which prescription drugs and treatments will be covered by their Medicaid programs. The findings in the report serve to assist federal and state policymakers and Congress, with the insight needed to make policy decisions designed to ensure the continued availability of necessary prescription drugs to people with chronic illnesses and disabilities. The report will also provide patient rights organizations, medical associations and educators, and persons with disabilities, with an understanding of health care policies, legislation, and initiatives that impact their lives.

The report will identify the states that are using ICER QALY-based cost studies or international drug prices to inform Medicaid coverage decisions; will describe how the studies are being used, e.g., as a benchmark or cost-threshold; and will identify if and how reliance on these reports has impacted coverage of drugs and treatments for beneficiaries. It will also describe methodological alternatives to QALYs that consider patient values and preferences. The report will include findings and make recommendations aimed at the U.S. Department of Health and Human Services, state governments, and Congress to address any identified issues and any barriers to accessing prescription drugs caused by reliance on these studies and/or international drug prices.

The full Notice of Funding Opportunity is posted at www.ncd.gov under the "Funding Opportunities" tab and on the NCD Home Page.

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