New Analysis Shows Using ICER’s Value Assessments Would Limit Access to Life-Saving Medicines in Medicare Part B

62 to 93 Percent of Medicare Part B Beneficiaries with Serious, Complex Conditions Could Lose Access to Their Medicines

Washington, D.C. (May 31, 2018) — If Medicare were to utilize one-size-fits-all value assessments like the Institute for Clinical and Economic Review’s (ICER) framework as the basis for coverage, 62 to 93 percent of patients with serious, complex conditions would face access barriers to life-saving medicines, according to a new analysis from Xcenda.

“The science of value assessment is not keeping pace with innovation, and we need better tools to measure the value of medicines,” said Stephen J. Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA). “We support advancing these tools from being focused on rigid, budget driven methodologies toward more flexible approaches that include perspectives of what patients value.”

The study compared ICER’s assessments regarding what treatments are of “highest value” to utilization of Medicare Part B medicines for four diseases. The data show of the more than 200,000 Medicare Part B beneficiaries with rheumatoid arthritis (RA), multiple sclerosis (MS), non-small cell lung cancer (NSCLC) and/or multiple myeloma (MM), nearly 140,000 patients might lose access to the treatments their physicians determined were best for them if an ICER-like standard were imposed.

As evidenced by the study, cost-effectiveness standards like ICER’s that prevent patients and doctors from making health care decisions could ultimately harm patient access to necessary treatments. In countries with centralized cost-effectiveness thresholds, patients have limited access. For example, in the United Kingdom, nearly 80 percent of cancer medicines reviewed by U.K. health officials between 2007 and 2014 had some form of access restriction.

View the full analysis here

About PhRMA
The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading innovative biopharmaceutical research companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier, and more productive lives. Since 2000, PhRMA member companies have invested more than $900 billion in the search for new treatments and cures, including an estimated $79.6 billion in 2019 alone.

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