ICER building barriers to access between patients and their medicines
ICER is building barriers to access between patients and their medicines, writes our policy director Jonathan Wilcox.
“ICER provides analysis that effectively functions as a price control on medicine,” Wilcox explains of the non-profit organization that receives major funding from insurance companies. “It targets a disease, writes a report to inform health insurers on the supposed cost-effectiveness of a drug and then insurers can decide whether or not to use that recommendation.”
He adds, “It does this through mathematical calculations known as “value frameworks” to justify the nonprofit’s preference to target certain drugs. But this is no unbiased test or dispassionate statistical measurement. It’s a Catch-22 in which patients can’t win because the ICER process determines they have a lesser quality of life than a healthy person – forever.”
Don’t take Jonathan’s word for it. Earlier this year, cancer survivor Bob Tufts authored a Huffington Post piece that warned there’s nothing nice about ICER.
ICER sides with insurance industry profits
ICER is pushing value frameworks, in part, because it serves their donors — insurance companies.
US News and World Report has a thoughtful piece from a health care advocate who says that ICER’s philosophy contradicts the foundational principles of medicine.
“If medicines are too expensive compared to an arbitrary value of treating the patient, ICER reports will recommend a lower price for the drug,” writes health advocate Seth D. Ginsberg, the co-founder of The Global Healthy Living Foundation. “Payers, such as private insurers and Medicare, can use the report to justify no longer covering a medication.”
Ginsburg also isn’t impressed with ICER’s PR damage control. He writes, “In the flurry of public relations efforts, ICER ended up undermining its own goal by omitting key facts and casting serious doubts about their transparency and credibility.”
In addition to ICER “omitting key facts,” it also values patients’ lives as worth less than healthy individuals. And of course, all of this presumes that the value framework gets the numbers right.
A study by the Partnership for Health Analytics Research has found that ICER overestimated the cost of two treatments by $7.1 billion. The Institute for Clinical and Economic Review initially predicted that two PCSK9 inhibitors would cost $7.2 billion. The real cost: approximately $83 million. ICER’s astronomical errors could have life-or-death consequences for patients. As our policy director and co-founder Jonathan Wilcox wrote earlier this year, “Promising and proven treatments are being pronounced as too expensive, even if doctors judge they can keep patients healthy and alive.”
Quote of the Day: ICER’s credibility may be reaching a tipping point
“ICER’s public defense indicates the group recognizes its credibility may be reaching a tipping point. Surely, it can’t maintain legitimacy if it not seen on the side of patients. Yet, ICER’s invitation for public comment only applies to certain aspects of its methodology — in a maneuver that would make any therapist question whether the participant is truly open to feedback.”
Video: Learn more about the risks of ICER’s “Value Frameworks”
Back in May, we brought together policymakers, providers and patients in order to identify the risks to patients from so-called “value-frameworks” that limit spending on new and innovative treatments for cancer and other serious diseases.