ICER (The Institute for Constantly Extracting Rebates)

Yesterday Sara Edmond, the chief operating officer of the Institute for Clinical and Economic Review and I danced around whether ICER is really patient-centered as she claimed, or rebate-centered as I did.

Ms. Edmond was a panelist at an excellent Financial Times sponsored US Healthcare Life Sciences Summit yesterday. She was joined by Peter Bach, Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center; Jonathan Emms, Senior Vice President, Global Health and Value, Pfizer; Jeff Myers, President, and CEO, Medicaid Health Plans of America and Leonard Schleifer, President and CEO, Regeneron.Praluent, the drug targeting people with untreatable high cholesterol was (along with Amgen’s Repatha) was considered low value by ICER and claimed that it should only be given to 15 percent of all patients who could benefit and at 80 percent of the list price.

As a Reuters article reports, Dr. Schleifer blasted ICER as unscientific:

“They did all the calculations and they said it’s X, which is ok. I could have lived with that. But … they said society can’t afford X, so we are going to say it’s one-third X,” Schleifer said during a panel discussion.

“They had value-based pricing, but they just decided that well we can’t afford it. That wasn’t scientific. There was no intellectual honesty there.”

ICER Chief Operating Officer Sarah Emond, on a panel with Schleifer, countered that budget impact is part of the equation.
“You’re attacking the science of an independent non-profit whose entire mission is tied to opening the black box of pricing,” she said.

Which lead me to challenge Edmond from my seat in the audience about ICER’s so-called independence.

I said:  “ICER is not independent, it is largely funded and overseen by PBMs and insurers.”

Edmond responded that most the money came from the Arnold Foundation but I pointed out that the Arnold foundation grant is a one-time thing.

I then said that ICER’s value metric reflects the PBM and insurer interest and ignores the patient value.  Further, the low QALY by default becomes a price control or price cap that doesn’t make drugs affordable or available.  Instead, the lower price only maximizes rebates that don’t go to patients. More important, for all her talk about opening a black box I noted that ICER never mentions that PBMs run the $115 billion rebate racket.

She said that since ICER doesn’t have rebate data they have to use list price.

People laughed and Schleifer asked:  You estimate everything else, why not rebates?

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