ICER CEO Steve Pearson has tried to salvage what's left of the organization's shredded credibility by claiming ICER's mission is to help patients. Specifically, ICER argues that it all it wants to do is "spur discussion among stakeholders to ensure that patients have access to the medications at prices that are aligned with the value they bring to patients.”
In fact, ICER was established to evaluate whether the price of drugs reflected value from the perspective of PBMs and health insurers. As ICER notes, it uses a "US health system perspective (i.e., focus on direct medical care costs)."
So when Pearson told MS patients today at an ICER meeting that the institute cannot quantify the benefits of new drugs to MS, it was just another evasion. In fact, ICER excludes the patient perspective because its mission to maximize the benefits to insurers and PBMs. Indeed, if spending exceeds that cap and therefore hurts the health system, ICER recommends changes in which MS patients would get medicines and how many would benefit. Of course none of these components of the ICER analysis were discussed. The same goes for the impact of limiting spending on each new drug to $915 million. The goal is to hide ICER's real face, which it shows to a fawning media and its PBM and insurer constituency.
Similarly, every time discussion turned to step therapy, how patients pay a share of the list price of a drug even as PBMs and insurers grab more rebates through price increases, Pearson steered the conversation in a different and self-serving direction. Instead, Pearson reminded everyone how drug prices rose and asserted that if MS drug prices had remained the same, then all of the medicines would be cost-effective.
Let's deal with this claim before turning to how ICERs value framework affects MS patients
To be sure, since 2011 the list price for Copaxone, Betaseron, Avonex, and Rebif have risen substantially to keep pace with the launch price of newer MS drugs in an apparent effort to maximize revenue as these injectable products lost market share. It also turns out that since 2011, rebates and discounts (which go to PBMs and insurers) were 60 percent of the price increase of these older products.
Further, since 2011 the primary driver in MS drug spending was the introduction of new medicines and greater use of oral MS medications. As the IMS study of drugs use notes: "Oral medicines now account for half of new treatment starts in 2015, steadily increasing since the introduction of these new treatment options six years ago and up from 26% in 2011."
But here too, rebates and discounts whittled down the actual increase in spending by about 30 percent according to my estimates based on Credit Suisse rebate data.
Further, even though ICER now attempts to calculate drug prices net of rebates, it is silent about the fact that these savings are pocketed by PBMs and insurers. (Indeed, Pearson is afraid to raise the issue.) And ICER is quiet about the fact even as payors rake in cash rebates that reduce the cost of medicines; they continue to charge patients up to 50 percent of the list price of medicines.
And price increases don't change the fact that If ICER had been in place 15 years ago, not one of the medicines used today would be considered cost effective at $150K per QALY
Between 2000-2015 the combined deficit in life years lost (those that would not be saved and the additional years lost) would have been 59000 with a loss of $17 billion in value.
Similarly, ICER claims not one MS drug developed since 2015 is cost effective. I estimate that between 2017-2022 limited use of these medicines would cost patients 11300 life years and $3.9 billion a year.
ICER’s public relations campaign to portray itself as the voice of the patient is deadly deception. It cannot be trusted to protect patients or fully include the value of new medicines to the people who are most in need of medical innovation.
In short, ICER’s policy prescriptions will cripple MS patients.