Health insurers searching to lower costs and maximize profits have begun to limit patients’ access to innovative drugs.  Most physicians, however, realize that this is a terrible idea.  Patient health suffers, particularly if patients don’t respond to existing treatments. The potential of breakthrough drugs to better treat chronic and life-threatening diseases goes untapped.  And physicians like me lose the ability to make crucial decisions about our patients’ care. No longer “my” patients, these men and women are more accurately under the care of the health insurers who dictate treatment options.

Nevertheless, a nonprofit known as the Institute for Clinical and Economic Review is playing right into the hands of insurers who want to cut drug costs, even if it means cutting patients’ best interests and personal safety out of the equation.

ICER, as the group is called, issues reports that present a “value-based price” for breakthrough drugs.  Voted on by its panel of experts, some of whom have never treated the disease for which the treatment is prescribed, the reports effectively give insurers an artificial price point to justify limiting patient access.  “ICER says we shouldn’t pay more than ‘X’ for this drug,” they can argue, “so we won’t.”

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About the Author

Samuel Louie, MD, is Professor of Medicine at the University of California, Davis, a practicing pulmonologist and a member of the Alliance for Patient Access.