Pharma accuses payers of using cash to sway U.S. cost watchdog

By Carly Helfand Jun 23, 2016 9:25am

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Drugmakers haven’t much cared for a Boston-based nonprofit’s cost-effectiveness assessments of their drugs--especially considering that the group usually turns out “too pricey” verdicts. And now, they're going on the offensive.

The Biotechnology Industry Organization (BIO) claims insurance companies have been funneling money to the organization--known as the Institute of Clinical and Economic Review (ICER)--in an effort to drive down overall drug costs.

The industry group wants a harder look into ICER’s ties to the insurance industry, arguing that payers are using ICER to get around paying for the care patients deserve.

"With every paycheck, you pay your insurance company and expect them to be ready when you need them. But when the time comes, they shirk their responsibility--hiding behind a fundamentally flawed third-party report that gives them cover to ration your care. Is it any surprise that insurers are a major funder of ICER?" BIO CEO Jim Greenwood wrote in a recent blog post.

On the other side of the coin, ICER’s COO, Sarah Emond, refuted the claims about missing transparency. "Our research isn’t about driving down drug costs--our mission is to open the black box of drug pricing so that the prices patients pay for medicines are aligned with how much those drugs improve patients’ lives," she told FiercePharma in an emailed statement. She pointed to the company's website, which states that less than 10% of ICER's funding comes from payer organizations, with 17% coming from "life science innovators."

ICER sparking ire from drugmakers is not all that new, though it’s been happening with increasing frequency. Just over the past couple of months, the group has taken aim at high-priced multiple myeloma meds and the new PCSK9 cholesterol-fighters, prompting pushback from companies such as Bristol-Myers Squibb, Amgen and Regeneron.

“That wasn’t scientific. There was no intellectual honesty there,” Regeneron CEO Len Schleifer recently said, as quoted by Reuters, in response to a report that the list price on the company’s Praluent needs a 67% cut to be cost-effective.

Now, the stakes could be getting higher when it comes to ICER’s assessments. The Centers for Medicare and Medicaid Services said this year that it could potentially begin using ICER’s analyses to slash reimbursement rates for some drugs. That effort would be part of a controversial program intended to focus Part B payments on drugs that provide the most value.

- see the blog post

Drug Prices ICER