The heated national debate over drug pricing headed to St. Louis this week, where a hearing was held Thursday over the value of new drugs designed to treat a deadly form of blood cancer.
A controversial group, the Institute for Clinical and Economic Review (ICER), which has been called the “de facto arbiter of the nation’s medicine chest,” held the first public meeting of its Midwest arm, the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC). The council’s goal is to review several newly-approved drugs that are now offering hope for patients afflicted with multiple myeloma, a common blood cancer. But recent history has shown that ICER and its affiliates are potentially negating patient-physician centered care and ignoring the value of medical treatments.
It’s estimated that more than 11,000 of the 24,000 people diagnosed with myeloma in the United States last year will die of the disease. The new drugs are designed specifically for myeloma patients who have not had luck with prior treatment. Yet ICER’s latest report has deemed these drugs too expensive to prescribe, despite their proven life-saving results.
One company which developed one of the drugs in question has challenged ICER’s methodology and lack of transparency. “Results produced by independent organizations should be informed by experts, made fully transparent and available, and undergo complete and independent peer review,” it said.
This week’s meeting in St. Louis and others like it around the country are having an impact on whether or not patients can access the drugs they need. Why? Because insurance companies and Pharmacy Benefit Managers (PBM) are increasingly listening to what ICER says regarding the drug’s price for its value – and is using the group’s analyses to determine if the drugs will be covered under their health plans or if patients will be forced to pay out of pocket.
Pharmaceutical executives have publicly stated that they will be using ICER’s analyses to justify its own coverage decisions. In one maneuver, the Pharmacy Benefit Manager (PBM) implemented a new pair of policies last fall, known as prior-authorization and step therapy, which require doctors to get insurer approval before prescribing new cholesterol drugs and force the patient to try a series of potentially less-effective drugs first. An ICER report on those particular drugs was released just weeks before the announcement.
One major problem with ICER is the group’s significant, if hidden, conflict of interest: It was founded by the health insurance industry and its foundations, and continues to receive major support from payers and Pharmacy Benefit Managers (PBM) alike. In 2013, two-thirds of ICER’s funding came from the Blue Shield Foundation of California. This certainly conflicts with its purported “independence.”
The names of fourteen members of the Midwest CEPAC were recently announced, and they will weigh in Thursday on whether or not these new cancer drugs provide enough value to justify coverage. It’s our hope they will do right by thousands of Americans afflicted with this disease who deserve to have a choice and a voice in their healthcare when a potential solution is within their grasp.