Who is protecting the ethical and cost decisions for patient access to treatment?

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I am going to introduce you to an organization that is supposed to be looking out for patients; keeping costs affordable, confirming people get the care they need and give recommendations that will improve their health. To help improve access to care and prevent economic hardship to patients, an academic research group called the Institute for Clinical and Economic Review (ICER) was created at Harvard Medical School. ICER formed in 2006 as a blending of expertise in health care ethics and evidence-based medicine. In 2013, ICER became an independent non-profit research institute. ICER has no statutory or regulatory power to make coverage or payment decisions.

In their report, Addressing the Myths About ICER and Value Assessment, http://icer-review.org/wp-content/uploads/2016/08/icer_myths_facts.pdf , ICER claims to produce independent, scientifically rigorous reports that help support discussions of how to achieve the broader goal of improving patient outcomes while making health care more affordable for patients now and in the future. In their literature, they state the need for prices that match the added value for patients, along with coverage policies that are fair for patients, insurers, health systems, and innovators. As advocates, ICER sounds like an answer to prayer as an instrument to provide oversight that will ensure open access to the treatments patients need while guaranteeing reasonable costs for medications and coverage. However, our friends at The Global Healthy Living Foundation have issued a fact-finding report to clarify the Institute’s true goals and methodology, GHLF RESPONDS TO ICER, http://ghlf.org/ICER-Response-Report.pdf .

The GHLF report tells us much about an organization that should be putting the wellbeing of people first without interference from any special interests related to this issue. What we find is an unbalanced approach to safeguarding the patient and physician medical decisions therefore restricting access to the most critical treatments. Unfortunately, as ARxC is aware, as with other groups that set evaluations for access and medical costs issues, some of the practices developed place patients in jeopardy and handcuff physicians from making the best medical choices for their patient’s treatment plans. An example is when insurance companies and Medicare use these reports to defend their cost benefit analysis and justify no longer covering certain drugs or requiring a ‘fail first’ policy; where the least expensive drug is prescribed to a patient first, even if a patient’s physician believes a different therapy is medically better for their condition. How can these practices ethically ensure improved health outcomes when the patient never comes out a winner?

ICER scarcely considers patient representation leaving little input from all industry stakeholders. To be objective in adapting their methods and practices ICER needs to set a place at their table for physicians, drug companies and patient advocate organizations. Without the vital contribution of these parties, ICER speaks in a dark, slanted vacuum. We are asking ICER for a place at the table, more honesty without ‘cherry-picking the information they share and to create an environment of transparency and integrity upheld by the conviction to put patients first as they encourage their voices be heard.

Dorothy Leone-Glasser, RN, HHC, CEO

Advocates for Responsible Care (ARxC)