3:56 PM
Sep 13, 2018
 |  BC Extra  |  Company News

Patient groups urge CVS to reconsider ICER-restricted formulary

At least 94 patient groups and individuals signed a letter urging CVS Health Corp. (NYSE:CVS) President and CEO Larry Merlo to reconsider a new formulary that would be restricted to drugs deemed cost effective by the Institute for Clinical and Economic Review (ICER). The formulary would allow clients to exclude from their plan any drug with a launch price that exceeds a cost-effectiveness ratio of $100,000 per quality-adjusted life year (QALY) gained as determined by ICER.

The new formulary, announced by CVS’s PBM CVS Caremark last month, will not exclude drugs FDA has designated as breakthrough therapies (see “CVS to Launch ICER-Restricted Formulary”).

The letter criticized ICER’s cost-effectiveness analysis, arguing that “policy decisions based on cost effectiveness ignore important differences among patients.” It also argues ICER’s analysis discriminates against the chronically ill, the elderly and people with disabilities.

CVS spokesperson Christine Cramer told BioCentury that the firm believes as more PBM clients adopt such programs, manufacturers will begin to moderate launch prices.

More often than not, ICER has determined the drugs it analyzed were overpriced (see “Arbiter of Value”).

The groups largely represent diseases where ICER has found treatments for the indications to not be cost effective, including the National Multiple Sclerosis Society, the Genetic Alliance, the International Foundation for Autoimmune & Autoinflammatory Arthritis and multiple mental health patient groups, including Mental Health America and the National Alliance on Mental Illness.

ICER has found only one of 14 MS drugs and zero of nine rheumatoid arthritis treatments to be cost effective. Although the two treatments for tardive dyskinesia, a side effect of anti-psychotic treatment, that ICER has reviewed were each deemed not cost effective, both compounds have breakthrough therapy designation from FDA and would not be eligible for exclusion from the formulary.

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