Report

Applying ICER Assessments in Medicaid Could Limit Patients’ Access to Medicines

PhRMA March 20, 2019

A new analysis from Xcenda found that if Medicaid were to use one-size-fits-all value assessments like the Institute for Clinical and Economic Review’s (ICER) framework as the basis for accessing a medicine, an estimated 42 to 99 percent of prescriptions to treat serious, complex conditions like cancer and multiple sclerosis may not be covered. This shows the dangerous effects using ICER’s value framework could have for some of the most vulnerable patients. Cost-effectiveness thresholds are the wrong basis for setting policy on access to medicines. In Medicaid, these thresholds would change access to more than 820,000 prescriptions for medicines that treat patients for serious diseases like multiple sclerosis (MS), rheumatoid arthritis (RA), non-small cell lung cancer (NSCLC), multiple myeloma (MM), and psoriasis.

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