The Daily Rise: Friday, May 13

ICER Admits: We Serve Payers

“ICER’s framework is specifically designed for payers,” Dr. Steven D. Pearson, founder and president of the Institute for Clinical and Economic Review, recently admitted in an interview with Evidence-Based Oncology’s managing editor Surabhi Dangi-Garimella.

That statement is a direct quote and says everything patients need to know about the independence and value of ICER’s tools.

  • Would you trust a value framework from an organization that openly admits its interests are aligned with the same companies that continually deny treatments?
  • How good is a pricing tool that’s brought to you by the same “payers” which make patients fail first?

It’s simple: Patients aren’t part of ICER’s equation.

PBM Rip-off Racket

Earlier this week, we explained pharmacy benefit managers or PBMs in our “Know Your Jargon” entry. With that primer, you’ll be prepared to read a recent post from our friends at Drug Wonks.com connecting the ongoing Justice Department investigation into pharmacy benefit managers and value frameworks.

PBMs are looking to use pricing tools from organizations such as ICER to establish their rebate policies and price structures.

“ICER plays, or seeks to play a role in setting prices and determining what products PBMs choose and insurers pay for that is central to enlarging and maximizing rebates,” Dr. Robert Goldberg writes. “And the PBMs are working closely with ICER to develop the price and access parameters of the contracts the U.S. Attorney for the Southern District of New York is investigating.”

This isn’t conjecture. Pharmacy benefits managers realize that value frameworks and pricing tools provide independent cover for denying treatments.

“ICER’s new program will make a huge difference by providing what is sorely needed: an independent, trusted source of information about new drugs,” stated Steve Miller, MD, Chief Medical Officer of Express Scripts, the nation’s largest pharmacy benefit manager. “I believe many payers and policy makers will find this information of critical importance as they evaluate the new drugs, and we look forward to using it to help us improve the ability of patients to get access to new, innovative drugs at a price the system can afford.”

State Spotlight: Same Prices with Controls

This November, California voters will have the chance to vote on a ballot measure that would impose price controls on treatments. Just don’t expect that ballot measure to save patients any money.

The Drug Price Relief Act would prohibit the state from paying more for a prescription drug than the lowest price paid by the U.S. Department of Veterans Affairs. But, the California Legislative Analyst’s Office, an independent panel of experts that provides impatial analyses of proposed legislation, is warning that the measure might not save patients one penny.

“It is ‘highly uncertain’ how much money the state of California would save if a ballot measure to cap drug prices passes in November — and it might not save money at all,” California Healthline notes in a summary of the LAO report. “The financial impact on the state is unclear.”

This assessment comes from a highly-respected and independent panel. The Legislative Analyst’s Office reached its conclusion on the futility of the Drug Price Relief Act for two reasons.

  1. The VA isn’t required to publish its lowest price for treatments — and at the state level — California can’t force a change upon a federal agency.
  2. If the measure passes, companies could respond by raising the prices it charges the VA.

Treatments That Incorporate Patient Feedback

Slowly but surely, more providers are catching on to the benefits of incorporating patient assessments in their treatment plans.

Kaiser Health News reports that, while patient-reported outcomes have been standard in the research phase, it’s only recently beginning to gain popularity in a clinical setting.

“The challenge is that we don’t capture [the response] in a way that we can use [like] we do for blood pressure,” Danielle Lavallee, a research assistant professor at the University of Washington, who has studied patient outcomes, told Kaiser Health News. Lavallee is also the lead author of a study published in the April issue of the journal Health Affairs that examines the movement to incorporate “patient-reported outcomes” into clinical care.

New smartphone apps and online data tracking programs are making it easier for patients to meticulously monitor their symptoms. Kaiser Health News shares the experience of one mother who now “doesn’t have to call every time she needs to recall when a medication was changed; it’s right there in the data.”

Every avaiable tool should be used to get the right treatment to the right patient. The key is to understand what works best for each patient — instead of a one-size-fits all policy.

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