[nradov]

Medicare doesn't use QALY thresholds to decide which treatments to cover. From a pure economic efficiency standpoint it probably should, but the politics around care rationing are so toxic that it can't be done.

[MichaelZuo]

Medicare doesn’t cover every orphan drug known to exist so surely they must? Unless they technically do for every drug, with some enormous caveats that effectively bars coverage?

[lmm]

They cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.

[MichaelZuo]

Then on what other basis do you believe they decide which orphan drugs to cover and which not? I don’t have insider knowledge but nonetheless I’m fairly certain it’s not based on pure random chance. If the implication is that it’s based on whatever political or lobbying faction is in vogue, that seems to be even worse than an economic measure?

[nradov]

This page provides a good description of how CMS determines which prescription drugs are covered under Medicare Part D.

https://medicareadvocacy.org/medicare-info/medicare-part-d/