The Inflation Reduction Act already threatens seniors’ access to care. Injecting ICER’s flawed value assessments to an already flawed government decision making about drug payment could further jeopardize patients’ ability to get the lifesaving treatments they need.
New analysis: Flawed assessments of a medicine’s value jeopardize patient access.
Under the Inflation Reduction Act, government bureaucrats will unilaterally decide how much a treatment selected for price setting is worth. To make matters worse, the price setting process is a black box. No one knows how exactly the government is determining the value of medicines selected for price setting or how much input it will use from patients, providers and other stakeholders — but, alarmingly, we do know they expressed significant interest in using flawed cost-effectiveness metrics. In the 2023 final guidance for the first year of the price setting process, CMS stated that it: “…will review and consider cost-effectiveness measures and studies that use such measures for initial price applicability year 2026.”
Concerningly, one organization eager to weigh in is the Institute for Clinical and Economic Review (ICER). The group holds itself out as an expert in assessing the value of medicines despite relying on outdated and discriminatory cost-effectiveness metrics. And, as patient advocates and others have warned, ICER’s one-size-fits-all approach that ignores the unique needs of different patient populations can lead to discriminatory outcomes. Government adoption of flawed value assessments like these could be devastating for patients.
A recent analysis by Cencora (formerly Xcenda) looked at treatment options for five serious, complex medical conditions that are covered by Medicare Part B and have been evaluated by ICER. Cencora considered what would happen if the government adopted ICER’s value assessments as the basis for its coverage decisions. The results were startling:
“If the government used ICER-like assessments to set prices for medicines, many patients could lose access to the treatments that they and their physicians had previously determined were best for them based on individual needs and preferences, after careful consideration of the nuances of a patient’s condition,” explained Cencora.
Government shouldn’t interfere in decisions best left to patients and their doctors. The Inflation Reduction Act already threatens seniors’ access to care. Injecting ICER’s flawed value assessments to an already flawed government decision making about drug payment could further jeopardize patients’ ability to get the lifesaving treatments they need.
