CVS Proposal Would Discriminate on Care

CVS Caremark has decided to allow the Institute for Clinical Economic Review (ICER) to decide what our lives are worth.  Patients, people with disabilities, physicians, and caregivers oppose their decision to exclude from coverage any drug not meeting a subjective “cost per quality-adjusted-life-year” (QALY) threshold determined by ICER. Join us in fighting for high quality, affordable care, and against coverage policies that discriminate against people with disabilities and serious chronic conditions. Value our health by asking what we value, rather than telling us what we’re worth.

Value Assessment, Frameworks and Tools

PIPC is very concerned that payers, physicians and policymakers are increasingly using value frameworks in the private sector – and potentially in the public sector – to determine patient access. Although labeled as “value frameworks,” many of these frameworks do not 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. PIPC supports assessing value to the patient using tools that are consistent with the goals of shared decision-making and personalized medicine.

Engaging Patients in Value-Based Payment

Health insurance companies, Medicare, State agencies all are working rapidly toward "value-based" payment models. But will they pay for care that patients value? For the transition to a value-based health system to really achieve outcomes that matter to patients, patients must have a seat at the table in the development of alternative payment models (APMs). We know that value means achieving outcomes that matter to patients and people with disabilities, and we stand ready for fight for new payment and delivery models to reflect their values.

Patient-Centeredness in Research

Since its founding, PIPC has been at the forefront of patient-centeredness in comparative effectiveness research (CER) – both its generation at the Patient-Centered Outcomes Research Institute (PCORI), and its translation into patient care. PIPC supports patient-centered CER that serves as a valuable tool to learn what works in health care and support good clinical decision-making. We look forward to the translation of PCORI’s work into effective shared decision-making tools.