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Quality-Adjusted Life Years (QALYs)

A metric commonly used to determine the value of a health care treatment.

Quality-Adjusted Life Years (QALY)

Quality-adjusted life years, or QALYs, is a metric commonly used to determine the value of a health care treatment. To calculate a QALY, you must assign a value to a persons life. Because the value assigned to seniors, the chronically ill, or people with disabilities is lower than that of a young, healthy person, QALYs could lead policymakers and payers to conclude that treatments for seniors, patients with chronic conditions or people with disabilities are not worth covering.1

In the Affordable Care Act, Congress included a critical safeguard with bipartisan support prohibiting Medicare from using cost-effectiveness assessments for making any coverage or payment decisions.

Prohibition on Using QALYs to Determine Access:

Further, The [Health and Human Services] Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII“ (Medicare).

Prior Prohibitions on QALYs

Section 504 of the Rehabilitation Act ensured that individuals with disabilities would not “be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination,” under any program offered by any Executive Agency, including Medicare. Title II of the Americans with Disabilities Act (ADA) extended this protection to programs and services offered by state and local governments.

How QALYs Are Calculated and the Impact on People with Disabilities and Patients with Chronic and/or Degenerative Illnesses