Institute for Clinical and Economic Review (ICER)

The Institute for Clinical and Economic Review (ICER) is a Massachusetts-based non-profit, which evaluates medical treatments, including prescription pharmaceuticals, based on effectiveness and cost. It receives much of its funding from industry special interests, including health insurance companies and their foundations.

History

Steve Pearson founded ICER in 2006, having previously served in the George W. Bush Administration[[1]], where he worked at the Centers for Medicare and Medicaid Services as a Special Advisor. The group has been called a "controversial nonprofit, which is increasingly influencing coverage decisions made by insurers."

Ties to the insurance and pharmacy benefit management industry

ICER is heavily funded by the health insurance industry. According to a report from the Capital Research Center, one grant from the Blue Cross Blue Shield Foundation of California accounted for about two-thirds of ICERs total funding in 2013. The report also found that “ICER lists 12 insurance companies, foundations, or trade associations as funders, including United HealthCare, the Aetna Foundation, and AHIP.”

According to ICER’s 2014 Form 990, Blue Shield of California Foundation also has guaranteed representation on ICER’s Board.

Steve Pearson, ICER’s president, is a former research fellow for America’s Health Insurance Plans (AHIP)[[2]], the insurance industry’s lobbying trade association in Washington, which spent nearly $10 million lobbying Congress in 2015. He also formerly worked for the UK’s National Institute for Health and Care Excellence (NICE).

Ties to the Arnold Foundation

In July 2015, ICER received a $5.2 million grant from the Arnold Foundation[[3]], a Houston-based group funded by former Enron trader John Arnold. An aspiring Koch brothers[[4]] imitator, his foundation has been widely criticized for its attempts to “gut retirement security” for public employees. Since receiving the grant, ICER has more than doubled its staff.

According to Jordan Marks, executive director of the AFL-CIO[[5]] backed National Public Pension Coalition, non-profits that took money from the Arnold Foundation have “rented their credibility to a right-wing ideologue…” The Foundation tactically exploits public policy areas with “big opportunities for any funder that does move aggressively into this niche.”

Express Scripts[[6]], the nation’s largest pharmacy benefits management organization, which negotiates drug prices on behalf of insurance companies, is also a financial supporter of ICER.

As one Huffington Post writer commented, "With John Arnold bankrolling ICER, it should be viewed with healthy skepticism."

Role as “Drug price watchdog”

ICER is best known for its drug assessment reports, which set their own “value-based” prices for newly approved prescription drugs entering the market. It provides a new perspective on drug pricing, but it also provides cover for payers to exclude prescription medications from formularies or implement burdensome prior-authorizations in order to effectively prevent patients from accessing new, and often expensive, medicines.

According to one consumer group, “Narrow, complex formularies are of particular concern to consumers who need specific medications as determined by their doctors. Yet payers can choose not to cover these medications, and insurers tend to make it extremely difficult for consumers to challenge these decisions; in some cases, they even hide the process by which to do so.”

In September 2015, ICER released an initial report[7] strongly criticizing the pricing of new drugs that treat high-cholesterol. A month later, Express Scripts, whose decisions affect tens of millions of patients , required that both available PCSK9 drugs “be subject to extensive prior authorization and step therapy.” This move kept costs low, and revenues (more than $100 billion in 2015) high for the company, which “rejected most prescriptions for the drugs.”

Steve Miller, Express Scripts’ Chief Medical Officer, stated upon receipt of the $5.2 million by ICER from the Arnold Foundation that “ICER’s new program will make a huge difference by providing what is sorely needed…I believe many payers and policy makers will find this information of critical importance as they evaluate the new drugs.”

Former Democratic congressman Dan Maffei has called the release of these reports a "strategically deploy[ment of] allies in the health care nonprofit world to camouflage their decisions under the cloak of economic analysis." ICER has also been called "a de facto arbiter for the nation’s medicine chest."

Pushback from cancer survivor community

In a Medium post entitled "Having Cancer Doesn't Make Me Worth Less," cancer survivor Jennifer Hinkel identifies "ICER’s not-so-secret ambition? To become the American analog of a group in the United Kingdom called NICE, which is far from 'nice.' NICE rations health care and keeps the newest high-tech cancer drugs off the market due to their cost. In fact, the policies of NICE have led to the UK having the poorest overall cancer survival rates in Western Europe. ... I’m a cancer survivor, and I take enormous offense at the suggestion that at any point in my life, I might have been worth less than one."

In a May 2016 Wall Street Journal article, a proposal to incorporate ICERs methodology into Medicare Part B drug coverage decisions was strongly criticized by the Partnership to Improve Patient Care and the American Association of People with Disabilities, who stated that "It is unimaginable that we would allow public programs to incorporate the use of QALYs [Quality Adjusted Life Years]," a measure of continued life versus the cost of a drug. es in Western Europe. ... I’m a cancer survivor, and I take enormous offense at the suggestion that at any point in my life, I might have been worth less than one."