St. Louis Meeting to Determine Cancer Patients’ Fate

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 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 nakedly profit-driven maneuver, the Pharmacy Benefit Manager 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 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.