Op-Ed: A Troubling Method of Curbing Health Care Costs Is Gaining Ground

Debbie Hart | October 16, 2019 | Opinion
‘Health plans are considering the adoption of value assessments to determine if certain drugs should be covered’
Debbie Hart

In Trenton and state capitols across the country, lawmakers are grappling with how to address the rising costs of prescription drugs. Policymakers are exploring solutions that help relieve the burden for patients and enable state governments to determine how to fairly price and value new therapies. State and federal legislators are right to find ways to control the cost of care, but no solution should compromise the innovation that makes it possible to discover groundbreaking treatments for patients.

New Jersey is a hub for the life sciences industry and these biopharmaceutical innovations. Our state is home to nearly 3,300 life sciences facilities, and the entire life sciences industry in the state creates more than 430,000 jobs. The work that is happening here is ensuring that patients everywhere get the innovative therapies they need, all while bringing tax revenue and philanthropy to our state. And these medical breakthroughs are happening at a more rapid pace than we’ve ever seen.

Unfortunately, one approach to rein in costs is troubling for patients — and threatens the very innovations that New Jersey makes possible for patients everywhere. Health plans are considering the adoption of value assessments to determine if certain drugs should be covered. The most common such approach comes from the Institute for Clinical and Economic Review, a small research group that uses a controversial method to determine the value of new drugs. ICER ignores real-life patient experiences in its reviews, instead basing its determinations of a drug’s value on financial considerations alone. Their method applies an arbitrary monetary value (in the range of $100,000) to one year of “perfect health.” This approach to drug value assessment is particularly disturbing as, among other things, it may be discriminatory, placing a lower value on the lives of the disabled and elderly.

But despite clear and serious drawbacks, ICER reviews are gaining credibility. In 2017, the Department of Veterans Affairs partnered with ICER to determine drug  and price negotiations. A year later, New York State used the findings of an ICER review to determine that it would not cover a groundbreaking drug that treats cystic fibrosis.

Could patients be denied life-saving drugs?

Our state is home to small and large biopharma companies that are working tirelessly to discover and develop new treatments that help our friends and family members who are managing complex health conditions. If ICER reviews are adopted more widely, it could deny patients access to new and life-saving drugs and bring medical innovation — in New Jersey and elsewhere — grinding to a halt. It would allow ICER, rather than physicians, to make treatment decisions for patients. And when patients can’t access the treatments they need, it can lead to complications, increased doctor visits, increased costs, trips to the emergency room, and even death.

This year, ICER opened up its current value assessment framework for suggestions, as it plans to introduce a final framework for all drug assessments in 2020 and beyond. This August, it published its proposed revisions, giving all stakeholders one more opportunity to be heard. Patients, biomedical professionals, advocates and anyone else who is concerned about access and innovation should make their voices heard by submitting comments to publiccomments@icer-review.org before the October 18 deadline.

In 2018, the U.S. Food and Drug Administration approved 59 novel drugs and has followed that up by approving an additional 26 novel drugs to date in 2019. These new therapies can be life-changing for patients who need them. If we lose sight of the true value that treatments have for patients and close our ears to their needs, New Jersey’s thriving biotechnology industry will suffer. Patients will suffer. Our state’s strong economy will suffer. Let’s solve cost of care issues, but not with one-size-fits-all solutions that threaten patients and innovation. We encourage everyone to weigh in with ICER this fall and watch closely as its new framework is unveiled.


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