In This Week’s Issue:
- Morning Consult: Allowing ICER into Medicare Does Not Achieve Value, click here to view the article.
- ICER Opens National Call for Proposed Improvements to its Value Assessment Framework, click here to view the press release
- Real Clear Health: Patient Advocates Need to Oppose Anti-Patient Policies, click hereto view the article.
- National Review: New Medicare Part B Rules Will Restrict Your Choice of Medication, click here to view the article.
- NPC Interview With Donna Cryer, Global Liver Institute, on Assessing the Value of Treatments for Liver Disease, click here to view the interview.
- PCORI Awards Nearly $1.2 Million to 22 Projects through Pipeline to Proposal Program, click here to view the press release.
1. Morning Consult: Allowing ICER into Medicare Does Not Achieve Value
In an op-ed published in Morning Consult, Donna Cryer, a President and CEO of the Global Liver Institute, a PIPC member, discusses how ICER's payer-focused perspective could harm patients by limiting patient access to medications. "It is unacceptable when payers, instead of patients and providers, use these reports to drive clinical decision-making based on mathematical assessments of so-called 'average value' – although I’ve never met an 'average' patient," she explains. "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."
“If Medicare Part B adopts ICER or any cost-based determination of value, it will be opening Pandora’s box to a dangerous world of rationing that has rightfully galvanized the patient community. Patients want access to the innovation brought forth by the President’s Precision Medicine Initiative so that health care is valuable to the patient, the ultimate payer.” Click here to view the article.
2. ICER Opens National Call for Proposed Improvements to its Value Assessment Framework
According to a recent press release, “To inform a planned 2017 update to the methods that underpin its evidence reports on new drugs and other health care interventions, the Institute for Clinical and Economic Review (ICER) is opening a national call for suggestions on how to improve its value assessment framework. We invite all interested parties to provide comments on the current ICER value framework, highlighting elements that are perceived to work well and others that should be re-examined. Where change is recommended, we are most hopeful of receiving specific proposals presenting alternative methods accompanied by arguments examining the potential advantages and disadvantages of multiple options. ICER will welcome comments though Monday, September 12th. We will use the suggestions received to guide internal review and further discussions with stakeholders, following which an updated version of the value framework will be finalized, announced, and used for ICER reports beginning in January 2017.” Click here to view the press release, including details on how to submit comments.
3. Real Clear Health: Patient Advocates Need to Oppose Anti-Patient Policies
As patient advocate Patricia Beggiato comments in Real Clear Health, “Being a patient advocate is an uphill battle, and those of us in this community are often fighting because of personal struggles or loss. Advocating for patients with rare diseases is even harder. There are fewer of us to make noise and certainly no pink wristband-clad football players helping to raise awareness, which is crucial to developing cures and expanding access to treatments… Insurance companies and pharmacy benefits managers (PBMs), which negotiate prices and set drug coverage plans for tens of millions of Americans, are requiring prior authorizations more and more. To justify this, they’re increasingly turning to reports from a Boston-based group called the Institute for Clinical and Economic Review (ICER). These reports analyze the cost of new drugs. Really, though, they provide public cover for insurance companies to require prior authorizations or implement other restrictive policies for accessing expensive treatments.”
“ICER’s review system should raise alarm bells among the patient community. It uses a metric common in the United Kingdom called Quality-Adjusted Life Years (QALYs), which often results in drug rationing. Jennifer Hinkel, a cancer survivor and health economist, described QALYs this way: ‘In the most basic terms: if you get sick, you become a fraction, and your time no longer has the same value as a fully healthy person’s time.’ Advocates for patients should join her in calling for insurance companies, PBMs and others to publicly reject ICERs reports. We need more innovation and awareness to find new treatments and cures. We don’t need excuses.” Click here to view the article.
4. National Review: New Medicare Part B Rules Will Restrict Your Choice of Medication
As National Review reported last week “[ICER] conducts cost-benefits analyses of medication to assess how cost-effective they are. In doing so, it uses a controversial methodology called Quality Adjusted Life Years (QALY) that say that if you are old, infirm, or sick, a year’s extra life will have a lower quality, so it should not be counted as equivalent to value of life of a healthy person. It’s a technique the United Nations uses to discount the extended lifespan of Americans, arguing that the last years of life aren’t equivalent to those of a young person in a poorer country… ICER's approach is raising eyebrows. Milena Izmirlieva, head of the Life Sciences research team at the analytical consultancy IHS, wrote on the company's blog, ‘[T]he activities of ICER should be carefully monitored because they have the potential to change the market access environment…ICER's reports – no matter whether they lack methodological rigour [sic] or not – may be used as ammunition by health insurers in their attempt to secure price discounts.’” Click here to view the article.
5. NPC Interview With Donna Cryer, Global Liver Institute, on Assessing the Value of Treatments for Liver Disease
Donna Cryer, JD, a liver transplant recipient and founder, president and CEO of the Global Liver Institute, is a passionate advocate for patients. On the eve of ICER’s public meeting to discuss its evaluation of these treatments, National Pharmaceutical Council President Dan Leonard sat down with Ms. Cryer to ask her thoughts about ICER, value assessments and how patients can become more engaged in these evaluations. “Unfortunately, for the most part, the patient perspective is missing from the ICER and other value frameworks. This is a tremendous problem, because when health care is decoupled from a focus on meeting the needs of patients, it fails to have value. ICER has involvement from a consumer organization and limited opportunities in its process for patient comment, but is overwhelmed by payer participation in the composition of its governing board, topic selection process and curation of evidence. Also, its methodology consistently misrepresents and excludes patient-centered evidence, patient-reported outcomes, and cost-offsets, perpetuating the myth of the average patient or standardized over personalized care.” Click here to view the interview.
6. PCORI Awards Nearly $1.2 Million to 22 Projects through Pipeline to Proposal Program
According to a recent press release, “The Patient-Centered Outcomes Research Institute (PCORI) has awarded funds totaling nearly $1.2 million to enable 22 projects to advance into the final phase of PCORI's ‘Pipeline to Proposal’ Awards program...‘It's gratifying to see how these projects have developed through the Pipeline to Proposal process,’ said Jean Slutsky, PA, MSPH, PCORI's Chief Engagement and Dissemination Officer.” Click here to view the press release.
In an op-ed published in Morning Consult, Donna Cryer, a President and CEO of the Global Liver Institute, a PIPC member, discusses how ICER's payer-focused perspective could harm patients by limiting patient access to medications. "It is unacceptable when payers, instead of patients and providers, use these reports to drive clinical decision-making based on mathematical assessments of so-called 'average value' – although I’ve never met an 'average' patient," she explains. "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."
“If Medicare Part B adopts ICER or any cost-based determination of value, it will be opening Pandora’s box to a dangerous world of rationing that has rightfully galvanized the patient community. Patients want access to the innovation brought forth by the President’s Precision Medicine Initiative so that health care is valuable to the patient, the ultimate payer.” Click here to view the article.
2. ICER Opens National Call for Proposed Improvements to its Value Assessment Framework
According to a recent press release, “To inform a planned 2017 update to the methods that underpin its evidence reports on new drugs and other health care interventions, the Institute for Clinical and Economic Review (ICER) is opening a national call for suggestions on how to improve its value assessment framework. We invite all interested parties to provide comments on the current ICER value framework, highlighting elements that are perceived to work well and others that should be re-examined. Where change is recommended, we are most hopeful of receiving specific proposals presenting alternative methods accompanied by arguments examining the potential advantages and disadvantages of multiple options. ICER will welcome comments though Monday, September 12th. We will use the suggestions received to guide internal review and further discussions with stakeholders, following which an updated version of the value framework will be finalized, announced, and used for ICER reports beginning in January 2017.” Click here to view the press release, including details on how to submit comments.
3. Real Clear Health: Patient Advocates Need to Oppose Anti-Patient Policies
As patient advocate Patricia Beggiato comments in Real Clear Health, “Being a patient advocate is an uphill battle, and those of us in this community are often fighting because of personal struggles or loss. Advocating for patients with rare diseases is even harder. There are fewer of us to make noise and certainly no pink wristband-clad football players helping to raise awareness, which is crucial to developing cures and expanding access to treatments… Insurance companies and pharmacy benefits managers (PBMs), which negotiate prices and set drug coverage plans for tens of millions of Americans, are requiring prior authorizations more and more. To justify this, they’re increasingly turning to reports from a Boston-based group called the Institute for Clinical and Economic Review (ICER). These reports analyze the cost of new drugs. Really, though, they provide public cover for insurance companies to require prior authorizations or implement other restrictive policies for accessing expensive treatments.”
“ICER’s review system should raise alarm bells among the patient community. It uses a metric common in the United Kingdom called Quality-Adjusted Life Years (QALYs), which often results in drug rationing. Jennifer Hinkel, a cancer survivor and health economist, described QALYs this way: ‘In the most basic terms: if you get sick, you become a fraction, and your time no longer has the same value as a fully healthy person’s time.’ Advocates for patients should join her in calling for insurance companies, PBMs and others to publicly reject ICERs reports. We need more innovation and awareness to find new treatments and cures. We don’t need excuses.” Click here to view the article.
4. National Review: New Medicare Part B Rules Will Restrict Your Choice of Medication
As National Review reported last week “[ICER] conducts cost-benefits analyses of medication to assess how cost-effective they are. In doing so, it uses a controversial methodology called Quality Adjusted Life Years (QALY) that say that if you are old, infirm, or sick, a year’s extra life will have a lower quality, so it should not be counted as equivalent to value of life of a healthy person. It’s a technique the United Nations uses to discount the extended lifespan of Americans, arguing that the last years of life aren’t equivalent to those of a young person in a poorer country… ICER's approach is raising eyebrows. Milena Izmirlieva, head of the Life Sciences research team at the analytical consultancy IHS, wrote on the company's blog, ‘[T]he activities of ICER should be carefully monitored because they have the potential to change the market access environment…ICER's reports – no matter whether they lack methodological rigour [sic] or not – may be used as ammunition by health insurers in their attempt to secure price discounts.’” Click here to view the article.
5. NPC Interview With Donna Cryer, Global Liver Institute, on Assessing the Value of Treatments for Liver Disease
Donna Cryer, JD, a liver transplant recipient and founder, president and CEO of the Global Liver Institute, is a passionate advocate for patients. On the eve of ICER’s public meeting to discuss its evaluation of these treatments, National Pharmaceutical Council President Dan Leonard sat down with Ms. Cryer to ask her thoughts about ICER, value assessments and how patients can become more engaged in these evaluations. “Unfortunately, for the most part, the patient perspective is missing from the ICER and other value frameworks. This is a tremendous problem, because when health care is decoupled from a focus on meeting the needs of patients, it fails to have value. ICER has involvement from a consumer organization and limited opportunities in its process for patient comment, but is overwhelmed by payer participation in the composition of its governing board, topic selection process and curation of evidence. Also, its methodology consistently misrepresents and excludes patient-centered evidence, patient-reported outcomes, and cost-offsets, perpetuating the myth of the average patient or standardized over personalized care.” Click here to view the interview.
6. PCORI Awards Nearly $1.2 Million to 22 Projects through Pipeline to Proposal Program
According to a recent press release, “The Patient-Centered Outcomes Research Institute (PCORI) has awarded funds totaling nearly $1.2 million to enable 22 projects to advance into the final phase of PCORI's ‘Pipeline to Proposal’ Awards program...‘It's gratifying to see how these projects have developed through the Pipeline to Proposal process,’ said Jean Slutsky, PA, MSPH, PCORI's Chief Engagement and Dissemination Officer.” Click here to view the press release.
