We need to talk about the cost of drugs – who influences prices, and who truly pays the price.
Imagine this awful scenario: Your child and your spouse each needs a life-saving drug. The decision over whether that drug is provided rests not with their doctor, but with a faceless bureaucrat hunched over a computer terminal. The soulless computer uses an unfeeling algorithm to weigh the future societal value of both your spouse and your child.
The results: The formula says your child is worth saving due to an expected future “value,” but your spouse is not worth the insurer’s investment. Your child gets the drug, but your spouse is out of luck.
An organization born by a radical left group and embraced by some bureaucrats called the Institute of Clinical and Economic Research (ICER) is practically a death panel. Its “value framework” formula estimates just how much a person’s life is worth. ICER then recommends limits on how much your potentially life-saving medicine should cost. Once the formula says the patient’s cost passes their projected value, the patient is cut off from further treatment for the year.
For bureaucrats, such caps are a cause for celebration. But for the human beings needing treatment, this can mean more suffering and even death.
Behind ICER’s neutral-sounding acronyms and “non-profit” status, lies the Arnold Foundation – a leftist hedge fund billionaire’s personal piggy-bank. The Foundation’s $23 million gift basket has bought it so much influence with ICER that they’ve been able to serve as a de facto controlling authority and make administrative decisions for the organization, including appointing board members.
We’ve seen ICER in action. In New York, policymakers have accepted recommendations to limit access to breakthrough cystic fibrosis drugs for Medicaid patients. This hurt patients while having a chilling impact on the development of new drug treatments.
ICER’s cold calculations are cruel, punitive, and frankly unhelpful. Its “research” thwarts incentives to innovate, while “value frameworks” fail to take into consideration the fact that treating someone with the best drug possible will likely reduce future hospitalization and long-term health care costs. ICER would have us believe that new, innovative treatments are not worth the investment, that the clinical benefits apparently do not outweigh the financial payoff.
This heartless approach restricts Americans’ health options, eliminating the voices of doctors and patients. Families have no say.
This is vitally important to Florida. In a state in which two-thirds of our population growth over the next ten years will be over the age of 65, anything that rations drug availability and creates artificial barriers to treatment is anathema to good public policy.
Value-based frameworks like ICER should be transparent in how they assess the benefit of treatment. Meetings to discuss these frameworks should be open to the public for input. Doctors, families, and patients should have a say about their prescriptions – not just billionaire hedge fund managers, callous special interest groups, or faceless bureaucrats.
The “value framework” espoused by ICER and others has absolutely no place in a civilized or humane society.
Sal Nuzzo is Vice President of Policy for the James Madison Institute, a non-partisan, free-market think tank based in Tallahassee, devoted to research and education on public policy issues.