When CVS uses cost effectiveness thresholds, patients with conditions such as Rheumatoid Arthritis, Multiple Sclerosis, and Osteoporosis are left out.
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What's the value of your life to CVS? CVS would like to exclude drugs from their formulary that don't meet a certain value threshold. This threshold is based on QALYs, which undervalue the lives of the disabled and chronically ill.
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RealClearHealth: Patients Caught in the Middle… Again.PIPC Chairman Tony Coelho sent a sharp message to CVS Caremark in his recent opinion published in RealClearHealth calling for solutions that engage and empower patients and people with disabilities, instead of another paternalistic, 20th century policy that tells patients what they’re worth instead of asking them what they value.
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Over 90 Stakeholder Groups to CVS: Don't Discriminate on CareIn August, CVS announced that they would offer new insurance plans that exclude drugs if they exceed a subjective “cost-effectiveness” threshold. This type of cost effectiveness analysis discriminates against people with disabilities and other vulnerable groups like the elderly because it assigns higher value to people in “perfect health” than people in less-than-perfect health.
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QALYs: Ethical Issues and Alternative Measures of ValueAs PIPC detailed in a recent White Paper, value assessment in general, and the use of cost-effectiveness in particular, is receiving renewed interest as a tool for controlling health care spending. Currently, the most common method for determining incremental cost-effectiveness of healthcare interventions is based on a calculation of quality-adjusted-life-years (QALY).
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Where We Stand on Value FrameworksAlthough labeled as “value frameworks,” ICER and others do not always accurately assess what patients value. In fact, they often are in conflict with stakeholder efforts to move towards a more patient-centric health care system and advance access to personalized and precision medicine.
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Formulary Restrictions Devalue And Endanger The Lives Of Disabled People"As policymakers around the world seek to manage rising drug expenditures, people with disabilities find ourselves increasingly concerned by the potential harms that cost-cutting measures may bring. The growing fight between health care purchasers and drug manufacturers offers yet another instance where people with disabilities and chronic conditions may find themselves caught in the cross-fire." Click here to read the newest PIPC Patient Blog by Ari Ne'eman.
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Responding to Stakeholder Input: Finding the Patient Voice in ICER's Value AssessmentsPIPC has partnered with Xcenda to quantify the extent to which ICER incorporates stakeholder input in its final assessments, particularly patients. Upon review of submitted comments, and comparing those comments to ICER’s final value assessments, Xcenda was able to quantify that patient perspectives were half as likely to be incorporated than other stakeholders. The report bolsters the argument that ICER needs to take steps to improve not only its process for engagement, but also its consideration of input received from patients.
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STAT News: Facing Criticism, CVS May Modify Its New Cost-Effectiveness Program for Covering Some DrugsAn 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.”
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Washington Examiner: Patient Groups Urge CVS Health to Drop Program Targeting Costly DrugsAn article in the Washington Examiner highlights the Partnership to Improve Patient Care's (PIPC) 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.
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BioPharma Dive: Patient Groups Attack CVS Use of ICER Metrics, Urge RethinkAn 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.”
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BioCentury: Patient Groups Urge CVS to Reconsider ICER-Restricted FormularyAn 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.
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'Patient Voices' on Value FrameworksIn response to CMS’ recently proposed Medicare Part B drug demonstration, dozens of individual patients and patient advocacy groups have mobilized to voice their concerns with the model’s use of "comparative effectiveness" research and "cost-effectiveness" data to make coverage decisions. Indeed, patients have expressed a wide range of concerns – from the reliance on assessments such as those generated by the Institute for Clinical and Economic Review (ICER), to the lack of patient engagement in the development of the new reimbursement model.
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PIPC Patient Blog: Donna CryerIn a recent post for the PIPC Patient Blog, liver transplant and IBD patient Donna Cryer examines the implications of shifting health policy landscape that promises to reward “value” in care rather than “volume” of services. As she explains, "It is unacceptable when payers, instead of patients and providers, use [comparative effectiveness] reports to drive clinical decision-making based on mathematical assessments of so-called 'average value' – although I’ve never met an 'average' patient. It is even more frustrating to think that public programs could sidestep patient protections embedded in the Medicare law through a nationwide 'demonstration project' that would allow these assessments to define treatment value."
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