An article in Inside Health Policy highlighted the Partnership to Improve Patient Care (PIPC) and Value Our Health's criticism of the Institute for Clinical and Economic Review's (ICER) use of the discriminatory quality-adjusted-life-year (QALY). The article astutely points out that the QALY metric has been spurned by Congress, restricting the Patient-Centered Outcomes Research Institute's (PCORI) use of the value assessment measures. The piece also amplifies PIPC's work in pushing for value assessments that incorporate patient preferences and don't utilize a one-size-fits-all approach. "The issue we are tackling today is making sure as we move down that path, that we don’t do it in a manner that discriminates against patients,” said PIPC Executive Director Sara van Geertruyden.
Pink Sheet: ICER Faces New Foe As Patient, Disability Alliance Takes Aims At Reports On Mayzent, Spravato
An article in The Pink Sheet highlighted the Partnership to Improve Patient Care (PIPC)'s involvement with Value Our Health -- a new initiative supported by organizations representations patients and people with disabilities. The article highlights Value Our Health's opposition to the Institute for Clinical and Economic Review's (ICER) use of the quality-adjusted-life-years (QALY) metric, nothing that the patients groups have long criticized the method as a one-size-fits-all approach to addressing the needs of patients. "It is disappointing that ICER continues to reference the QALY as the 'gold standard' despite that it distorts and misrepresents how patients value their own lives, and it can lead to insurers and the government to deny care to people who would benefit from it," said PIPC executive director Sara van Geertruyden. "There are other ways of conducting value assessment, it's just they just really don't have the investment that ICER has."
An article for STAT News highlighted Partnership to Improve Patient Care's (PIPC) Disability Advocate Ari Ne’eman's comments on the importance of assessing the value of medicines using treatment metrics that are specific to particular conditions or diagnosis, instead of relying on the flawed quality-adjusted-life-years (QALY) method. Ne’eman noted that due to the fact that it is inherently discriminatory against certain patients, the use of the QALY method in determining coverage for health plans is “of grave concern.” The article also amplifies Value Our Health's criticism of discriminatory value assessments during a briefing the group held, in which patient groups discussed objections to the Institute for Clinical and Economic Review’s (ICER) recent analysis of a Novartis MS drug and a new Johnson & Johnson antidepressant.
Inside Sources: This Nonprofit Might Make It Harder for Those With Depression to Get the New ‘Miracle’ Drug
"An article for Inside Sources highlighted the Partnership to Improve Patient Care’s (PIPC) concerns regarding the Institute for Clinical and Economic Research’s (ICER) use of the quality-adjusted-life-years metric. The article amplifies comments from PIPC Executive Director Sara van Geertruyden and PIPC Disability Advocate Ari Ne’eman about ICER’s use of discriminatory value metrics in their reviews of prescription drugs, noting that these methods make patients “pawns in a profit game between Big Pharma and insurers.” “The real issue we have been trying to tackle is that it is not appropriate for patients with disabilities to be caught in the middle,” stated van Geertruyden. “Where the patient and the disability community are aligned is, their access should not be restricted as part of this path forward."
On Friday, June 14, Politico's Prescription Pulse Newsletter highlighted the Partnership to Improve Patient Care (PIPC) and over 30 patient and disability groups concerns about the Institute for Clinical and Economic Research's (ICER) 2020 Value Assessment Framework. The newsletter covers the groups' letter to ICER that criticizes its use of the quality-adjusted-life-years (QALY) metric, amplifying the coalition's message that ICER should abandon the use of discriminatory cost-effectiveness analyses. "The groups — including diabetes, epilepsy, pain and mental illness organizations — want ICER to get rid of a metric known as quality-adjusted life years that is typically used in cost-effectiveness studies to try and measure how much a therapy can improve a life," the post states. "Critics argue the measure places a lower value on the lives of people with disabilities and overestimates their burden. The coalition said it wants ICER to use models that are 'open-source, transparent, and able to generate disease-specific information.'"
In an article for Inside Health Policy, Partnership to Improve Patient Care (PIPC) Executive Director Sara van Geertruyden highlighted concerns from patient advocates about the use of comparative effectiveness data being used to limit patient access to drugs. She pointed out the problems with a "one-size-fits-all" approach, touting the Patient Centered Outcomes Research Institute's (PCORI) approached to comparative effectiveness research over the payer-focused approach taken by the Institute for Clinical and Economic Review (ICER). “Comparative effectiveness improves decision making by making sure the right patient gets the right treatment at the right time," said van Geertruyden. "But when you are talking about allowing coverage decisions based on averages to drive health care decision-making for individual patients, you allow payers and governments to drive one-size-fits-all decisions for patients."
STAT News: Facing Criticism, CVS May Modify Its New Cost-Effectiveness Program for Covering Some Drugs
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.”
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.
Health care value is being defined through new payment incentives and value standards proposed and implemented by health care payers, policy-makers, and providers, but has long discounted the inclusion of patient perspective. As part of an effort to advance a “new direction” for the government agency, the Centers for Medicare & Medicaid Servcies (CMS) has issued a Request for Information (RFI) seeking insights on how to better advance innovation in care and payment more representative of patient-centered care as part of the agency’s Innovation Center (CMMI). At the Partnership to Improve Patient Care (PIPC) Annual Forum, Ms. Amy Bassano, the Acting Director of CMMI, explained how CMS might test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.
In an op-ed published in RealClearHealth, PIPC Chairman Tony Coelho examines the limitations of quality-adjusted-life-years (QALYs) and how this tools for value-assessment may systematically discriminate against patients and individuals with disabilities. As he writes, "Underlying all this is the key question we must ask ourselves when considering any policy related to the payment and delivery of health care: for whom are we creating this policy? Who is the ultimate stakeholder? If the answer is not the people served by health systems -- patients and people with disabilities -- then we have a serious problem."
PIPC Chairman Tony Coelho recently penned a blog for HuffPost, complimenting steps that are being taken that show progress in shifting toward value-based healthcare decisions. “While a tremendous amount of work remains to be done, policymakers took two steps recently that show progress is possible. One was approval by the Senate Finance Committee of the CHRONIC Care Act, a bipartisan bill (yes, they still exist!) whose success is attributable to significant stakeholder engagement and that, if enacted, will help to meet real patient needs.”
Chairman's Corner: Patient Voices, Patient Value: Stepping Out of the Ivory Towers into the Real World
In a blog published by The Huffington Post, Partnership to Improve Patient Care (PIPC) Chairman Tony Coelho urged members of the new Congress and new administration to listen to real patients and embrace health care solutions for that cater to all patients, caregivers and people with disabilities. "Patients wanted a voice in research and in health care policymaking, because, too often, traditional research is irrelevant to the goals we have for our health and our lives," Coelho wrote. Coehlo also noted that while Congress continues to focus on improving the "value" of healthcare, it is crucial for patients to have a voice in defining this value in their healthcare plans.
In response to Washington Post opinion article, "Keep this part of Obamacare," PIPC Chairman Tony Coelho emphasizes the fact that while the Center for Medicare and Medicaid Innovation (CMMI) appears to be doing "some good work," it is also in serious need of changes to protect patients. "The Innovation Center created significant (if unintended) risks with some models that patients identified as going too far and driving “one-size-fits-all” care in stark contradiction of the nation’s drive to develop targeted therapies under the Precision Medicine Initiative and Cancer Moonshot," Coelho writes. "We all want health care to pay for value and not volume, but the real question is value for whom?"