Drug Costs

Patient Advocates Line Up Against ICER

December 11, 2018 10:54 am

When CVS Caremark announced this fall that it would use data from the Institute for Clinical and Economic Review (ICER) to set prices, nearly 100 patient advocate groups, physicians, and organizations representing individuals with disabilities sent a letter to CEO Larry Merlo asking him to reconsider. The group argued ICER’s “cost-effectiveness analysis … discriminates against the chronically ill, the elderly and people with disabilities” by “using algorithms that calculate their lives as ‘worth less’ than people who are younger or non-disabled.”


The letter’s signers included the Brain Injury Association of America, the National Alliance on Mental Illness, the National Multiple Sclerosis Society, and the Pediatric Congenital Heart Association.


As our previous blog post noted, criticisms of ICER by patients groups are common.


While it did not sign the CVS Caremark letter, the Institute for Patient Access (IfPA) has been one of the leading voices questioning ICER’s methodology for determining drugs’ value. After ICER issued a report this spring on cystic fibrosis treatments, IfPA warned ICER’s recommendations would “dampen future investment in further treatments for the disease.” IfPA also has explained how ICER data has restricted patient access to migraine treatments.


In an October 2018 Commonwealth Magazine op-ed, Susan Linn, president and CEO of the Epilepsy Foundation, an organization that signed the CVS Caremark letter, accused ICER of trying to ration care. Groups like the American Lung Association and Lungevity have called ICER’s analyses “cursory” and “incongruous with the basic tenets of precision medicine.”


There’s more.


Last year, ICER issued a report on abuse-deterrent opioids. In a Morning Consult op-ed, Robert Goldberg and Peter Pitts from the Center for Medicine in the Public Interest (CMPI) criticized ICER’s cost-benefit calculations. The two explained, “ICER had promised to consider the societal impact of reducing the use of opioids. But it never considered the $50 billion in lost productivity, early death, increased crime, and more incarceration due to inappropriate opioid use.” ICER also was “silent on the explosion in the number of infants abandoned by addicted parents or … left to die alone.”


Goldberg and Pitts concluded ICER’s report would “perpetuate” the opioid crisis. Officials from CPMI also have concluded ICER “robs myeloma patients of life and hope.”


So, if patients don’t benefit from ICER’s analyses, who does?


In that September 2018 myeloma report, CPMI said, “ICER’s price recommendations are designed to benefit insurers and pharmacy benefit management firms that fund the group.”