Patient groups urge CVS Health to drop program targeting costly drugs
by Joe Williams
Nearly 100 patient groups urged CVS Caremark on Wednesday to reverse a decision allowing clients to drop coverage for expensive drugs that don't meet a cost-effectiveness threshold.
The new policy from CVS Health's pharmacy benefit arm comes as the Trump administration undertakes a broader effort to lower drug costs. The company plans to focus its new evaluations on treatments with price tags over $100,000 that do not result in better quantity and quality of life. It will base coverage decisions on analysis from the Institute for Clinical and Economic Review, a nonprofit routinely blasted by the pharmaceutical lobby.
Ninety-five patient groups, including the Vietnam Veterans of America, the Alliance for Aging Research, and the National Alliance on Mental Illness joined in the criticism, claiming the reports "ignore important differences among patients" while relying on a 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 groups wrote to CVS.
Institute reports, the groups said, replace personal healthcare decisions with "an opaque algorithm based on average study results that do not address the needs of different patients and special populations."
A CVS spokesperson didn't immediately respond to a request for comment. The complaint was led by the Partnership to Improve Patient Care, an organization that counts drug industry associations like Pharmaceutical Research and Manufacturers of America as members.
The White House is weighing several measures intended to help lower prices for prescription drugs, including changes to the current drug rebate program. Pharmaceutical manufacturers argue that middlemen pharmacy benefit managers unfairly profit off the system, a claim the industry has denied.
CVS Health is in the midst of a $69 billion merger with insurer Aetna. While the American Medical Association and others are urging the Department of Justice to block the deal, the agency is reportedly close to approving it.
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.
The article in its entirety can be read below.