U.S. policymakers have long rejected using rigid formulas to decide who gets medicines in this country. But proposals like Most Favored Nation (MFN) pricing wouldn’t just import foreign prices, but also the flawed values of countries they reference. Many foreign governments rely on Quality Adjusted Life Year (QALY) metrics that assign numerical values to patients’ lives based on health status to determine who gets treatment and who doesn’t.
QALYs systematically disadvantage seniors, people with disabilities and those with chronic illnesses by assigning their lives a lower value than a healthy individual, making them less likely to receive the latest medicines and best care. These blunt tools would embed discrimination into government price setting based on one-size-fits-all assumptions that distort treatment value and access. Congress banned the use of QALYs and similar cost-effectiveness metrics to determine issues like coverage or reimbursement in Medicare.
What this looks like in practice:
Under a QALY‑based system like Sweden’s, a patient with multiple sclerosis (MS) is assigned a health value of about 0.37, meaning each year of life counts as just over one‑third of a healthy year in cost-effectiveness calculations. As a result, MS treatments that slow disease progression can be labeled “too expensive” on paper, allowing the government to deny access even if the treatment would meaningfully improve the patient’s quality of life.
Examples of QALY measurements by country:
The bottom line:
MFN would tether U.S. drug prices to foreign systems that rely on QALYs, importing not just prices, but value judgments the United States has deliberately rejected. Any American affordability policy must protect—not restrict—access to the medicines patients need.
Brianna Allen
Brianna is a Senior Director on PhRMA’s Public Affairs team focusing on communications strategies and activities around Medicare, Medicaid and access to medicines. Prior to joining PhRMA, she served as a strategic communications advisor at the FDA’s Center for Devices and Radiological Health and worked as a director of strategic communications on FGS Global’s health care team. She started her career in journalism and spent nearly a decade covering domestic policy issues, including federal health policy for POLITICO. She enjoys spending time outdoors exploring Northern Virginia with her husband, two toddlers and corgi puppy.
Brianna Allen headshot