Fentanyl and QALYs take center stage in House Energy & Commerce’s first health

The House Energy and Commerce health care subcommittee tackled fentanyl and QALYs in its first hearing of the new Congress — and lurking in the background of the conversation was the debt ceiling’s effect on entitlement programs.

Why it matters: The debt ceiling is going to be the issue that colors all health care debates this year. Today was only a small preview.

• “If my Republican colleagues want to discuss how best to protect the disability community, we should consider the impacts of proposed cuts that the Republican majority wants to make in exchange for a debt ceiling increase,” Rep. Frank Pallone said during his opening remarks.

Here’s what else you need to know from the hearing:

1. Lawmakers are still far from a consensus on how to prevent the spread of fentanyl-related substances, despite having discussed the topic for nearly five years now.

• Republicans continue to rally around the HALT Fentanyl Act, which would permanently classify the substances as Schedule 1 drugs. That would create mandatory minimum prison sentences for individuals convicted with related crimes. 
• While some Democratic committee members like Rep. Angie Craig said they support class-wide scheduling, others are standing firm against the policy. The Biden administration supports permanent scheduling, but with specific guardrails not included in the GOP bill.

2. There’s a catch to Chair Cathy McMorris Rodgers’s legislation seeking to prohibit QALYs from federal programs. (It’s a personal issue to her, since her son was born with Down syndrome, and QALYs devalue treatments for people with disabilities who have shorter life expectancy.)

• The GOP-sponsored bill to stop the use of metrics that peg a drug’s value to the quantity and quality of life years gained from its use has garnered some interest from Democrats, including Rep. Anna Eshoo, the subcommittee’s ranking member.

• But the bill could have adverse consequences, Families USA Executive Director Frederick Isasi argued during the hearing. The legislation’s broad language would create a loophole for pharmaceutical companies to gouge prices for drugs, he said.
• McMorris Rodgers said after Isasi’s testimony she’s open to working on the bill’s language.
• Worth noting: Very few Democrats stayed in the hearing room long enough to weigh in on QALYs.