Protecting Medical Innovation in New Jersey

New Jersey’s innovative life sciences industry develops groundbreaking treatments and cures that Patients everywhere depend on. Medical innovation also supports a healthy New Jersey economy. But a threat is looming. Patients and innovation itself may be endangered by organizations like the Institute for Clinical and Economic Review (ICER), that use questionable methods to determine drug value and access. Join us in our efforts to advocate for policies and solutions that help Patients access the medicines they need and promote a thriving life sciences industry in New Jersey.

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Why Medical Innovation May Be Under Threat?

In an effort to control the cost of care, health plans and policymakers are exploring the use of value assessments to determine whether or not a certain drug should be covered. Plans use value assessments – sometimes called “cost-effectiveness” reviews – to assess if a drug’s price is justified by how effectively it treats a condition or disease. Payers use that information to decide if a new treatment will be covered for Patients.

What is ICER?

The Institute for Clinical and Economic Review (ICER) is a Boston-based research group that uses a controversial method to determine the value of drugs, based on an arbitrary evaluation of the value of one year of “perfect health”. ICER regularly creates “value assessment” reports on new drugs that analyze how well a drug works, its economic value, and other elements of value. ICER uses the “Quality Adjusted Life Years (QALY)” technique to determine the cost-effectiveness of drugs, using a random evaluation of the monetary worth of one year of “perfect health”.

ICER ignores individual Patient preferences in its reviews, and the QALY disregards individual circumstances such as age, condition, or unique Patient needs. The QALY methodology and similar approaches to drug value assessment may also be discriminatory, as it places a lower value on the lives of the disabled and elderly, and threatens to undermine the Patient-physician relationship.

If ICER principles are adopted in New Jersey, ICER reviews could be devastating for medical innovation – halting the discovery of new therapies and cures, limiting Patient access to treatments, and dampening the hope that new and innovative medicines give to those living with rare, chronic, or complex or life-threatening conditions.

What does the Growing Threat of ICER Mean?

CVS Health, the New York Medicaid program, and the U.S. Department of Veteran Affairs (VA) have all started using ICER drug value assessments to decide if Patients can access certain new drugs. Last year, in an attempt to deny patients access to a life-changing treatment, New York Medicaid announced that the cystic fibrosis drug Orkambi was not worth the cost. Now, New Jersey has formed a new Office of Medicaid Innovation, which may have its sights set on adopting a similar review process for new treatments.

What ICER Means for Patients When Innovation Stops?

If ICER reviews are used more widely, it could deny Patients access to new and life-savings drugs. It would allow ICER – rather than physicians – to make treatment decisions for patients. One estimate found that, if Medicare used an ICER-style model, 59 to 93 percent of prescriptions to treat complex conditions may not be covered. When Patients can’t access the treatments they need, it can lead to complications, increased doctor visits, trips to the ER, and even death.

What incentive would life sciences companies have to innovate if the drugs they produce can’t reach the Patients who need them? ICER could bring innovation to a halt.

How You Can Take Action?

Because Patients Can’t Wait®, any solution to control health care costs in New Jersey must promote innovation, incorporate the unique needs of Patients, and ensure access to care. Join us in our efforts to protect medical innovation and access to life-changing treatments for New Jerseyans and all Americans. Sign up and we’ll send you email opportunities to take action online and in your community.

Plus, help us spread the word and lend your voice on the importance of protecting innovation in New Jersey’s life sciences industry for Patients. Here are sample social media posts that can be customized to fit your unique voice and perspective.

  • New Jersey’s innovation ecosystem creates life-saving treatments and cures that give Patients hope, but it’s under threat. Help preserve access to life-saving care by taking action at https://www.bionj.org/protect-medical-innovation
  • How do we define drug value? Regulators in New Jersey could be asking themselves this question to determine access to innovative, life-changing treatments. Help us protect innovation and the Patient voice in drug value assessment: https://www.bionj.org/protect-medical-innovation
  • Patients must be able to access innovative, life-saving treatments with no delays or roadblocks. If New Jersey adopts ICER-style methods to review the value of drugs, Patients would pay the price. Learn more here: https://www.bionj.org/protect-medical-innovation
  • Medical innovation puts new treatments in the hands of Patients. It supports the NJ economy. And it may be under threat if one-size-fits-all approaches to drug value assessments are adopted. Take action to protect innovation here: https://www.bionj.org/protect-medical-innovation
  • Medical innovations enable us to discover new cures for Patients in New Jersey and beyond and support a robust NJ economy. Join us in our efforts to advocate for policies and solutions that promote a thriving life sciences industry in NJ. https://www.bionj.org/protect-medical-innovation

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