​An article in STAT News notes that CVS may consider changes to its new cost-effectiveness program as a result of backlash from over 90 leading advocacy organizations representing patients, people with disabilities, physicians, and caregivers. Spearheaded by the Partnership to Improve Patient Care (PIPC), stakeholder groups criticized CVS Caremark’s decision last month to incorporate the Institute for Clinical and Economic Review’s (ICER)”quality-adjusted-life-year” metric in some of its coverage choices. “From a clinical care perspective, QALY calculations ignore important differences in individual patient’s needs and preferences,” the letter states. “From an ethical perspective, valuing individuals in ‘perfect health’ more highly than those in ‘less than perfect’ states of health, is deeply troubling.” Dr. Troyen Brennan, a CVS executive vice president and chief medical officer, responded to the letter saying that “It behooves us to spend some time to understand the concerns of the disability community and, if necessary, modify the measures so the process treats every life as being of equal value. We’ll go with the program we have now, but we’re looking for ways that we might modify it down the line.”

 In This Week’s Issue:
 
1. Over 90 Stakeholder Groups to CVS: Don't Discriminate on Care, see details below.
2. Chairman’s Corner:  Tony Coelho Discusses How “Cost-Effectiveness” Measures Used by CVS Caremark Discriminate Against People with Disabilities, Click here to read the blog.
3. Health Affairs: Blogs on CVS Caremark use of QALY Thresholds to Withhold Coverage, see details below.
4. Column: Calculating patient’s ‘worth’ by simple formula is wrong, click here to read the column.
5. The Hill: CMS Should Reconsider and Withdraw the Potentially Harmful Step Therapy Guidance, click here to read the op-ed.
6. Other Upcoming ICER Studies: Angiodema, Asthma, Opioid Use Disorder, click here to provide patient input.
7. GHLF: A Patient’s Guide to Insurance Enrollment, click here to view.   
8. The PCORI Blog: PCORI's New Policy on Data Management and Data Sharing — A Step Forward for Open Science,click here to read the blog.
9. 2018 Health Care Payment Learning and Action Network (LAN) Fall Summit, click here to register. 
10. 2018 PCORI Annual Meeting, click here for details.
11. Upcoming Events and Webinars, see details below.
12. Medical Journal Articles, see details below.
13. AHRQ Effective Program Updates, see details below. 

An article in BioPharmaDive highlights the latest pushback on efforts to establish quantitative frameworks for valuing medicines. These efforts, spearheaded by the Partnership to Improve Patient Care (PIPC), criticized CVS Caremark’s decision last month to “incorporate value-based drug pricing analyses in some of its coverage choices.” The letter, composed by many prominent groups including the American Association of People with Disabilities, the National Alliance on Mental Illness, and Vietnam Veterans of America, argues that their “main issues with ICER’s framework are not new and mirror some of the criticisms laid out by the drug industry’s trade lobby PhRMA. The article highlights that Tony Coelho, President of PIPC and former Congressman who led efforts to pass the Americans with Disabilities Act, took a strong stance on CVS’ decision characterizing it as an “outdated policy that has no place being referenced as a value-based initiative.”

An article in BioCentury highlights the Partnership to Improve Patient Care (PIPC)’s recent letter to CVS Health Corp, which voices the importance of a reconsideration of a new formulary that would be restricted to drugs deemed cost effective by the Institute for Clinical and Economic Review (ICER). This formulary, the article states, would “allow clients to exclude from their plan any drug with a launch price that exceeds a cost-effectiveness ration of $100,000 per-quality adjusted life year (QALY) gained as determined by ICER.” The letter, composed by 94 patient groups and individuals, criticized ICERS’s cost effectiveness analysis by arguing that cost effectiveness inherently ignores existing differences among patients. “CVS spokeperson Christine Cramer told BioCentury that the firm believes as more PBM clients adopt such programs, manufacturers will begin to moderate lunch prices,” the article states 

An article in the Washington Examiner highlights the Partnership to Improve Patient Care (PIPC)'s recent letter to CVS Caremark, which voices opposition to CVS' use of quality-adjusted-life-year metric. Joined by over 90 stakeholder groups, PIPC criticizes CVS for ignoring important differences among patients while relying on a flawed one-size-fits-all assessment. "Cost-effectiveness analysis discriminates against the chronically ill, the elderly and people with disabilities, using algorithms that calculate their lives as 'worth less' than people who are younger or non-disabled," the letter states. 

In This Week’s Issue:
 
1. Chairman’s Corner:  Tony Coelho Discusses How “Cost-Effectiveness” Measures Used by CVS Caremark Discriminate Against People with Disabilities, Click here to read the blog.
2. AHRQ Seeks Topic Suggestions for Future Evidence Reviews, click here for details.
3. Patient EngagementHIT: How Does Provider Burnout Impact Patient Care Quality, Care Access? Click here to read the article.
4. Other Upcoming ICER Studies: Prostate Cancer, Asthma, Opioid Use Disorder, click here to provide patient input.
5. Supporting Wellness: A Survey of Lived Experience and Research Priorities for Depression and Bipolar, click here to take the survey.
6. Watch: Everyone Included Episode 9 — PCOR/CER Designing Solutions, click here to watch the video. 
7. 2018 PCORI Annual Meeting, click here for details.
8. Upcoming Events and Webinars, see details below.
9. Medical Journal Articles, see details below.
10. AHRQ Effective Program Updates, see details below. 

PIPC Chairman Tony Coelho has penned a new blog in Real Clear Health that criticizes CVS Caremark’s use of the quality-adjusted life year (QALY) metric when deciding treatment coverage. “CVS touted its program as an ‘innovation,’ but it is anything but. Under the new policy, CVS would offer employers policies that exclude drugs from their formularies if they exceed a subjective ‘cost-effectiveness’ threshold. CVS would rely on a deeply flawed value assessment model developed by the Institute for Clinical and Economic Review (ICER) in determining whether treatments fall below a $100,000 ‘cost per quality-adjusted-life-year’ limit. Patient advocates have been down this road before. In the early 1990’s Oregon proposed using a similar ‘cost-effectiveness’ formula in Medicaid, but ultimately backed away from it in part due to concern that it discriminated against people with disabilities and would violate the Americans with Disabilities Act.”

In This Week’s Issue:
 
1. Real Clear: Tony Coelho Discusses How “Cost-Effectiveness” Measures Used by CVS Caremark Discriminate Against People with Disabilities, click here to read the blog.
2. PMC to Receive PCORI Award to Develop Personalized Medicine Research Agenda, see details below.
3. SWHR White Paper: Speeding Progress in Migraine Requires Unraveling Sex Differences, click here to read the white paper.
4. Patient EngagementHIT: Patients Interested in Telehealth Tech, But Improvements Are Key, click here to read the article.
5. The PCORI Blog: Engaging People Who Are Hard to Reach, click here to read the article.
6. Other Upcoming ICER Studies: Spinal Muscular Atrophy, Asthma, Opioid Use Disorder, click here to provide patient input.
7. Supporting Wellness: A Survey of Lived Experience and Research Priorities for Depression and Bipolar, click here to take the survey.
8. PCORI Board of Governors Meeting: September 7, 2018, click here for details.
9. 2018 PCORI Annual Meeting, click here for details.
10. Upcoming Events and Webinars, see details below.
11. Medical Journal Articles, see details below.
12. AHRQ Effective Program Updates, see details below. 

In This Week’s Issue:
 
1. AJMC: Is One Answer Good Enough for All? Defining Value in Healthcare, click here to read the article.
2. Patient EngagementHIT: Why Quality Measures Must Reflect Patient Values, Care Experience, click here to read the article.
3. Upcoming ICER Studies: Prostate Cancer, Spinal Muscular Atrophy, Cardiovascular Disease, Asthma, Opioid, Hereditary Angioedema, Amyloidosis, click here to provide input.
4. Supporting Wellness: A Survey of Lived Experience and Research Priorities for Depression and Bipolar, click here to take the survey.
5. AcademyHealth Blog: Patient-Centered Approaches: Accepted & Increasingly Expected, click here to read the blog.
6. NYT: This Drug Is Safe and Effective. Wait. Compared With What?
7. CARE About Fibroids Call for Patient Stories: Uterine Fibroids, click here to submit your story.
8. National Meeting on Active Duty and Veteran Women’s Health, see details below.
9. 2018 PCORI Annual Meeting, click here for details.
10. PCORI Peer Review Opportunity, click here to apply.
11. Upcoming Events and Webinars, see details below.
12. Medical Journal Articles, see details below.
13. AHRQ Effective Program Updates, see details below. 

In This Week’s Issue:
 
1. Joint Letter with 50 Signatures to CMMI Emphasizing Early Patient Engagement in New Payment Models, click here to read the letter. 
2. CVS Launches Program To Exclude New Drugs Deemed Not Cost Effective, click here to read the article.
3. CSC Submits Comment Letter to ICER Regarding Prostate Cancer Treatment, see details below.
4. Other Upcoming ICER Studies: Spinal Muscular Atrophy, Cardiovascular Disease, Asthma, Opioid, Hereditary Angioedema, Amyloidosis, click here to provide input.
5. Supporting Wellness: A Survey of Lived Experience and Research Priorities for Depression and Bipolar, click here to take the survey.
6. CMS Guidance: Medicare Advantage Prior Authorization and Step Therapy for Part B Drugs, see details below.
7. CARE About Fibroids Call for Patient Stories: Uterine Fibroids, click here to submit your story.
8. National Meeting on Active Duty and Veteran Women’s Health, see details below.
9. 2018 PCORI Annual Meeting, click here for details.
10. PCORI Peer Review Opportunity, click here to apply.
11. Upcoming Events and Webinars, see details below.
12. Medical Journal Articles, see details below.
13. AHRQ Effective Program Updates, see details below. 

In This Week’s Issue:
 
1. Joint Letter with 50 Signatures to CMMI Emphasizing Early Patient Engagement in New Payment Models, click here to read the letter.  
2. PIPC Patient Blog: Our Children Are Worth It, click here to read the blog.
3. National Meeting on Active Duty and Veteran Women’s Health, see details below.
4. Supporting Wellness: A Survey of Lived Experience and Research Priorities for Depression and Bipolar, click here to take the survey.
5. Patient EngagementHIT: Patient-Provider Communication, Education Key for Opioid Prescribing, click here to read the article.
6. The PCORI Blog: PCORI-Funded Projects Aim to Use Telehealth to Address Disparities, click here to read the blog.
7. 2018 PCORI Annual Meeting, click here for details.
8. PCORI Peer Review Opportunity, click here to apply.
9. Upcoming Events and Webinars, see details below.
10. Medical Journal Articles, see details below.
11. AHRQ Effective Program Updates, see details below.

In This Week’s Issue:
 
1. PIPC Submits Comments on HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, click here to read the letter.
2. PIPC Patient Blog: Our Children Are Worth It, click here to read the blog.
3. Quality, Not Quantity, Should Guide Medicare Coverage for Heart Valve Disease Treatment, click here to read the op-ed.
4. Op-Ed: The Disability Trap, click here to read the op-ed.
5. Patient EngagementHIT: Best Practices for Patient-Centered Appointment Agenda-Setting, click here to read the article. 
6. 2018 PCORI Annual Meeting, click here for details.
7. PCORI Peer Review Opportunity, click here to apply.
8. Upcoming Events and Webinars, see details below.
9. Medical Journal Articles, see details below.
10. AHRQ Effective Program Updates, see details below.

In This Week’s Issue:
  
1. PIPC Patient Blog: Our Children Are Worth It, click here to read the blog.
2. PIPC Submits Comments on HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, click here to read the letter.
3. PCORI Funding Announcement: Implementation of Effective Shared Decision Making Approaches in Practice Settings -- Cycle 2 2018, click here to apply.
4. PCORI Peer Review Opportunity, click here to apply.
5. Op-Ed: Quality, Not Quantity, Should Guide Medicare Coverage for Heart Valve Disease Treatment, click here to read the op-ed.
6. Patient EngagementHIT: Consumer-Centric Healthcare Lags Amid Value-Based Care Priorities, click here to read the article.
7. CMS Webinar: Technical Expert Panels: Developing and Implementing a TEP for Better Quality Measures, Click here to register. 
8. 2018 PCORI Annual Meeting, click here for details.
9. Upcoming Events and Webinars, see details below.
10. Medical Journal Articles, see details below.
11. AHRQ Effective Program Updates, see details below. 

This post was originally published as a July 17, 2018 article in Disabled World.

By: Stephanie Bozarth 

​Should one consider the life of a person with a disability less valuable than the life of a person without a disability? Alarmingly, states are increasingly relying on policies that do just that, in order to determine the value of health care services and treatments. For children suffering from life-threatening and debilitating disorders, like my daughter, reliance on any standard that considers her life less valuable than someone without a disability, is simply unacceptable.

In This Week’s Issue:
  
1. PCORI Funding Announcement: Implementation of Effective Shared Decision Making Approaches in Practice Settings -- Cycle 2 2018, click here to apply.
2. PCORI Peer Review Opportunity, click here to apply.
3. Kaiser Health News: A Hospital’s Human Touch: Why Taking Care In Discharging A Patient Matters, click here to read the article.
4. IFPA: Patients Shouldn’t Have to ‘Fail First,’ click here to watch the video. 
5. Patient EngagementHIT: What Are the Top Patient Engagement Measures in Value-Based Care? Click here to read the article.
6. CMS Webinar: Technical Expert Panels: Developing and Implementing a TEP for Better Quality Measures, Click here to register. 
7. The PCORI Blog: The Latest Published Results of PCORI-Funded Studies, click here to read the blog.
8. Study: Specialty Drug Coverage Varies Across Commercial Health Plans In The US, click here to read the study.
9. Upcoming Events and Webinars, see details below.
10. Medical Journal Articles, see details below
11. AHRQ Effective Program Updates, see details below